Individual
DR. PRACHAK T SIRIPRAKORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1966 OPITZ BLVD, SUITE 9, WOODBRIDGE, VA 22191-3304
(703) 491-2179
Mailing address
PO BOX 309, OAKTON, VA 22124-0309
(703) 491-2179
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101042285
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006000193
—
VA
Enumeration date
10/04/2006
Last updated
07/09/2007
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