Provider Demographics
NPI:1013276021
Name:TANPITUKPONGSE, TEERATH PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:TEERATH
Middle Name:PETER
Last Name:TANPITUKPONGSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 SITUS CT
Mailing Address - Street 2:STE 170
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4279
Mailing Address - Country:US
Mailing Address - Phone:919-834-2767
Mailing Address - Fax:919-834-0234
Practice Address - Street 1:3200 BLUE RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-781-1437
Practice Address - Fax:919-787-4870
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2012-020132085N0700X, 2085R0202X
VA01012709262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCU252DMedicare PIN