Provider Demographics
NPI:1710132980
Name:THONGCHAROEN, MARUT K
Entity Type:Individual
Prefix:DR
First Name:MARUT
Middle Name:K
Last Name:THONGCHAROEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 N HIATUS RD
Mailing Address - Street 2:REGIONAL ADMIN OFFICE
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:888-447-2362
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:2800 BENEDICT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-6840
Practice Address - Country:US
Practice Address - Phone:510-357-8300
Practice Address - Fax:510-620-3924
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251033208M00000X
CAC00141591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist