Individual
MR. PRAKORB ISARIYAWONGSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
129 SIMPSON ROAD, SUITE 108, BROWNSVILLE, PA 15417
(724) 785-9696
(724) 785-7225
Mailing address
129 SIMPSON ROAD, SUITE 108, BROWNSVILLE, PA 15417
(724) 785-9696
(724) 785-7225
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD033993L
PA
208D00000X
General Practice Physician
Primary
MD033993L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005869240004
—
PA
01
—
020031897
PALMETTO MEDICARE
—
01
—
0708585
UNITED MINE WORKERS
—
01
—
129649
HIGHMARK
PA
01
—
18700
HEALTH AMERICA
PA
01
—
202932
UPMC
PA
01
—
251310157
UNITED HEALTH CARE
—
01
—
60542
UNISON
—
01
—
7938474011
CIGNA
PA
Enumeration date
08/20/2006
Last updated
08/17/2011
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