Individual
CHANARONG SUPHAVEJKORNKIJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 WOODVALLEY CT, REISTERSTOWN, MD 21136-4629
(443) 881-4777
(443) 881-4739
Mailing address
5 WOOD VALLEY CT, REISTERSTOWN, MD 21136-4629
(443) 881-4777
(410) 881-4739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0018970
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790611100
—
MD
Enumeration date
08/14/2006
Last updated
03/21/2016
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