Provider Demographics
NPI:1801844451
Name:NILUBOL, CHANIGAN (MD)
Entity Type:Individual
Prefix:
First Name:CHANIGAN
Middle Name:
Last Name:NILUBOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANIGAN
Other - Middle Name:
Other - Last Name:SMAVATKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:DIVISION OF NEPHROLOGY, DEPARTMENT OF MEDICINE BOX 52
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-9183
Practice Address - Fax:202-444-9183
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47839207R00000X
NY245894207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00894815OtherRAILROAD MEDICARE
MD196661YT2Medicare PIN