Active NPI
Chanarong Suphavejkornkij, M.D.
- Specialist
- Reisterstown, MD
National Provider Identifier
1396758371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- D0018970
- Practice address
- 5 Woodvalley CT
Reisterstown, MD 21136-4629 - Phone
- (443) 881-4777
- Fax
- (443) 881-4739
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | D0018970 | MD | Primary |
Addresses
Primary practice location
5 Woodvalley CT
Reisterstown, MD 21136-4629
Mailing address
5 Wood Valley CT
Reisterstown, MD 21136-4629
Phone (443) 881-4777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 790611100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458518400000",
"number": "1396758371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 WOOD VALLEY CT",
"city": "REISTERSTOWN",
"state": "MD",
"postal_code": "211364629",
"telephone_number": "443-881-4777",
"fax_number": "410-881-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 WOODVALLEY CT",
"city": "REISTERSTOWN",
"state": "MD",
"postal_code": "211364629",
"telephone_number": "443-881-4777",
"fax_number": "443-881-4739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPHAVEJKORNKIJ",
"first_name": "CHANARONG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2016-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MD",
"license": "D0018970",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "790611100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reisterstown, MD
- Strength, Courage & Wisdom Behavioral Health
- Lindsay Chaney Strowd, MD
- Suman Chibb DDS PA
- Summerfield Eye Associates
- Superbloom Psychiatry LLC
- Supreme Health and Rehabilitation Services, LLC
- Supreme Health and Rehabilitation Services, LLC
- Supreme Health and Rehabilitation Services, LLC
- Ronald Surdin, O.D.
- Marsha Ann Swilley, LCPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.