Provider Demographics
NPI:1306811328
Name:SRICHAROEN, NATTAPONG (MD)
Entity type:Individual
Prefix:DR
First Name:NATTAPONG
Middle Name:
Last Name:SRICHAROEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 E QUINCY ST STE 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2034
Practice Address - Country:US
Practice Address - Phone:210-223-7500
Practice Address - Fax:210-223-9075
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9047207RC0000X, 207RI0011X
NE24815207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI31773Medicare UPIN
PA091823Medicare ID - Type Unspecified
PA101352575Medicaid