Provider Demographics
NPI:1992861488
Name:SYVANTHONG, CHOCKEO (MD)
Entity type:Individual
Prefix:
First Name:CHOCKEO
Middle Name:
Last Name:SYVANTHONG
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 1:1 VAUXHALL PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8615
Mailing Address - Country:US
Mailing Address - Phone:919-423-5264
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:1107G W WING
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-423-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0601972085R0202X
NC2011-002382085R0202X
VA01012515952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology