Individual
PANYAMOL PAM KITTIPONGDAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
501 OFFICE CENTER DR STE 190-195, FORT WASHINGTON, PA 19034-3220
(215) 836-7900
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS018946
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103374660-0001
—
PA
Enumeration date
11/04/2013
Last updated
02/13/2018
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