Individual
TANIT PHUPITAKPHOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 QUINCY AVE, BROCKTON, MA 02302-2803
(508) 941-7268
(508) 894-0412
Mailing address
130 QUINCY AVE, BROCKTON, MA 02302-2803
(508) 941-7268
(508) 894-0412
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
286943
MA
207RI0200X
Infectious Disease Physician
Primary
14235993-1205
UT
207RI0200X
Infectious Disease Physician
286943
MA
Other
Enumeration date
06/25/2016
Last updated
03/11/2026
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