Provider Demographics
NPI:1396978706
Name:HIRUNYACHOTE, PHENPAN (MD)
Entity type:Individual
Prefix:
First Name:PHENPAN
Middle Name:
Last Name:HIRUNYACHOTE
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 1:3501 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2703
Mailing Address - Country:US
Mailing Address - Phone:443-453-3634
Mailing Address - Fax:
Practice Address - Street 1:MAUMENEE B 110 600N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-6052
Practice Address - Fax:410-955-1985
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program