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Individual

CHANIKA PHORNPHUTKUL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-8361
(401) 444-3288
Mailing address
593 EDDY ST, HASBRO 122, PROVIDENCE, RI 02903-4923
(401) 444-8361
(401) 444-3288

Taxonomy

Speciality
Code
Description
License number
State
207SG0202X
Clinical Biochemical Genetics Physician
Primary
MD10121
RI
2080P0205X
Pediatric Endocrinology Physician
10121
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
CP46587
RI
Enumeration date
05/23/2006
Last updated
12/21/2011
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