Provider Demographics
NPI:1669854048
Name:RUANGCHOTVIT, KRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:RUANGCHOTVIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1261
Mailing Address - Fax:704-384-3145
Practice Address - Street 1:9929 REA RD STE 201
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6439
Practice Address - Country:US
Practice Address - Phone:704-316-1650
Practice Address - Fax:704-316-1651
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT2098792084P0800X
NC2019-009572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry