Provider Demographics
NPI:1780970467
Name:TONGMA, CHAWAT (MD)
Entity type:Individual
Prefix:
First Name:CHAWAT
Middle Name:
Last Name:TONGMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THANAPORN
Other - Middle Name:
Other - Last Name:THONGMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155/2 MOO 6, SOI BANGKOK-NONTHABURI 2
Mailing Address - Street 2:
Mailing Address - City:MUANG
Mailing Address - State:NONTHABURI
Mailing Address - Zip Code:11000
Mailing Address - Country:TH
Mailing Address - Phone:662-527-2182
Mailing Address - Fax:
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-2026207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH109392Medicare Oscar/Certification