Provider Demographics
NPI:1255515573
Name:PANBOON, DAVID (APA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PANBOON
Suffix:
Gender:M
Credentials:APA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7848 BUTTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1548
Mailing Address - Country:US
Mailing Address - Phone:210-428-5528
Mailing Address - Fax:
Practice Address - Street 1:4375 FAIR LAKES CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4234
Practice Address - Country:US
Practice Address - Phone:571-432-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical