Provider Demographics
NPI:1730279951
Name:CHINGCHAI WANIDWORANUN MD PLLC
Entity Type:Organization
Organization Name:CHINGCHAI WANIDWORANUN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINGCHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANIDWORANUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7033-878-0999
Mailing Address - Street 1:4001 9TH ST N APT 228
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1954
Mailing Address - Country:US
Mailing Address - Phone:703-387-0999
Mailing Address - Fax:703-387-0911
Practice Address - Street 1:4001 9TH ST N APT 228
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1954
Practice Address - Country:US
Practice Address - Phone:703-387-0999
Practice Address - Fax:703-387-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02493Medicare PIN