Provider Demographics
NPI:1558824870
Name:HANSRIVIJIT, PANUPONG (MD)
Entity type:Individual
Prefix:MR
First Name:PANUPONG
Middle Name:
Last Name:HANSRIVIJIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 S. FRONT STREET, UPMC PINNACLE INTERNAL MEDICINE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104
Mailing Address - Country:US
Mailing Address - Phone:717-231-8532
Mailing Address - Fax:717-231-8535
Practice Address - Street 1:205 S. FRONT STREET, UPMC PINNACLE INTERNAL MEDICINE
Practice Address - Street 2:SUITE 3C
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104
Practice Address - Country:US
Practice Address - Phone:717-231-8532
Practice Address - Fax:717-231-8535
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program