Provider Demographics
NPI:1841220894
Name:WANIDWORANUN, CHINGCHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINGCHAI
Middle Name:
Last Name:WANIDWORANUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHINGCHAI
Other - Middle Name:
Other - Last Name:WANID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02493C01Medicare PIN