Provider Demographics
NPI:1891225082
Name:PUTTHAPIBAN, PRAPAIPAN (MD)
Entity Type:Individual
Prefix:MISS
First Name:PRAPAIPAN
Middle Name:
Last Name:PUTTHAPIBAN
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 1:1712 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6930
Mailing Address - Country:US
Mailing Address - Phone:804-344-9848
Mailing Address - Fax:804-554-5395
Practice Address - Street 1:1712 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6930
Practice Address - Country:US
Practice Address - Phone:804-344-9848
Practice Address - Fax:804-554-5395
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine