Provider Demographics
NPI:1821015652
Name:BOONSWANG, NARONGSAK GUEVARA (MD)
Entity Type:Individual
Prefix:
First Name:NARONGSAK
Middle Name:GUEVARA
Last Name:BOONSWANG
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 1:85 MCNAUGHTEN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2174
Mailing Address - Country:US
Mailing Address - Phone:614-751-8846
Mailing Address - Fax:614-751-8894
Practice Address - Street 1:2380 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5024
Practice Address - Country:US
Practice Address - Phone:941-206-0325
Practice Address - Fax:941-766-0423
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130413208G00000X
PAMD418882208G00000X
CO54194208G00000X
MT77362208G00000X
OH35-126473208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA522325498OtherTAX ID
CO94373779Medicaid
PA1885635OtherBLUE SHIELD
PA1016990120001Medicaid
PA522325498OtherTAX ID