Provider Demographics
NPI:1922063023
Name:BURAPAVONG, THAVIJ DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:THAVIJ
Middle Name:DAVID
Last Name:BURAPAVONG
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 1:416 GATEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4718
Mailing Address - Country:US
Mailing Address - Phone:336-882-2531
Mailing Address - Fax:336-884-8254
Practice Address - Street 1:416 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4718
Practice Address - Country:US
Practice Address - Phone:336-882-2531
Practice Address - Fax:336-884-8254
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07194OtherBLUE CROSS BLUE SHIELD
NC1310041OtherUNITED HEALTHCARE
NC7901794Medicaid
NC5987957-001OtherCIGNA HEALTHCARE
NC1310041OtherUNITED HEALTHCARE
NCC85439Medicare UPIN