Provider Demographics
NPI:1891744512
Name:TOOCHINDA, PANITDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PANITDA
Middle Name:
Last Name:TOOCHINDA
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 1:264 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3336
Mailing Address - Country:US
Mailing Address - Phone:407-862-8377
Mailing Address - Fax:407-862-8883
Practice Address - Street 1:264 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3336
Practice Address - Country:US
Practice Address - Phone:407-862-8377
Practice Address - Fax:407-862-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 29981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059989100Medicaid
FLD20971Medicare UPIN