Provider Demographics
NPI:1285898023
Name:NGAMRUENGPHONG, SAOWANEE (MD)
Entity type:Individual
Prefix:
First Name:SAOWANEE
Middle Name:
Last Name:NGAMRUENGPHONG
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 1:4940 EASTERN AVE
Mailing Address - Street 2:A BUILDING, 5TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-1793
Mailing Address - Fax:410-550-7861
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:A BUILDING, 5TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-1793
Practice Address - Fax:410-550-7861
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109387207R00000X
TXBP10032775390200000X
MDD81862207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003733500Medicaid
MD113054400Medicaid
MD113054400Medicaid
FL003733500Medicaid