Individual
DUANGNED TANTAWANICHPISAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 E WOOD ST, SUITE 401, SPARTANBURG, SC 29303-3040
(864) 560-6654
(864) 560-7353
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23714
SC
208M00000X
Hospitalist Physician
Primary
23714
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237149
—
SC
01
—
SC42835019
MEDICARE PIN
SC
01
—
SC42839068
MEDICARE PIN
SC
Enumeration date
07/17/2006
Last updated
10/10/2023
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