Provider Demographics
NPI:1528272572
Name:CHONGSWATDI, NATAVOOT NICK (MD)
Entity type:Individual
Prefix:
First Name:NATAVOOT
Middle Name:NICK
Last Name:CHONGSWATDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1100
Mailing Address - Fax:304-691-1183
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1100
Practice Address - Fax:304-691-1183
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV23192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013314Medicaid
OH2884053Medicaid
KY7100060010Medicaid
WV3810013314Medicaid