Provider Demographics
NPI:1730239039
Name:SUANLARM, CHINTANA (MD)
Entity type:Individual
Prefix:DR
First Name:CHINTANA
Middle Name:
Last Name:SUANLARM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2326
Mailing Address - Country:US
Mailing Address - Phone:215-849-6555
Mailing Address - Fax:215-849-6555
Practice Address - Street 1:5129 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2326
Practice Address - Country:US
Practice Address - Phone:215-849-6555
Practice Address - Fax:215-849-6555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035781L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013359OtherKEYSTONE MERCY HEALTH PLA
PA0011018950001Medicaid
PA0045826000OtherKEYSTONE HEALTH PLAN EAST
PA20909MD035781LOtherHEALTH PARTNERS
PA0110189501OtherAMERICHOICE
PA0045826000OtherKEYSTONE HEALTH PLAN EAST
PAB36942Medicare UPIN