Provider Demographics
NPI:1881650026
Name:SUTTIRATANA, PIMPA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PIMPA
Middle Name:
Last Name:SUTTIRATANA
Suffix:
Gender:F
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:HC68 BOX 1000 SUITE 3
Mailing Address - Street 2:COMMUNITY HEALTH FOUNDATION OF LOGAN
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-9620
Mailing Address - Country:US
Mailing Address - Phone:304-239-3888
Mailing Address - Fax:304-239-3811
Practice Address - Street 1:HC68 BOX 1000 SUITE 3
Practice Address - Street 2:COMMUNITY HEALTH FOUNDATION OF LOGAN
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-9620
Practice Address - Country:US
Practice Address - Phone:304-239-3888
Practice Address - Fax:304-239-3811
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV12253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0094391000Medicaid
D49460Medicare UPIN