Individual
DR. NUTAPORN SUKONTASUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8115 MAPLE LAWN BLVD, SUITE 135, FULTON, MD 20759-2681
(443) 804-1173
Mailing address
8315 ACADEMY RD, ELLICOTT CITY, MD 21043-6687
(443) 804-1173
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1848
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11431664
CAQH
—
Enumeration date
08/18/2006
Last updated
01/15/2017
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