Organization
PRAKORB MEDICAL ASSOCIATE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAKORB ISARIYAWONGSE M.D. (OWNER)
(724) 785-9696
Entity
Organization
Contact information
Practice address
129 SIMPSON RD, BROWNSVILLE, PA 15417-9689
(724) 785-9696
(724) 785-7225
Mailing address
129 SIMPSON RD, BROWNSVILLE, PA 15417-9689
(724) 785-9696
(724) 785-7225
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
033993L
PA
261QP2300X
Primary Care Clinic/Center
033993L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000586924 0003
—
PA
Enumeration date
06/13/2010
Last updated
06/13/2010
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