Provider Demographics
NPI:1174694483
Name:CHARNSANGAVEJ, CHUTAPORN (MD)
Entity type:Individual
Prefix:DR
First Name:CHUTAPORN
Middle Name:
Last Name:CHARNSANGAVEJ
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 1:1411 S POTOMAC ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4536
Mailing Address - Country:US
Mailing Address - Phone:303-695-4800
Mailing Address - Fax:303-695-4821
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:SUITE 450
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-695-4800
Practice Address - Fax:303-695-4821
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0042540207V00000X, 209800000X
CO42540173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07552343Medicaid
CO07552343Medicaid
I24933Medicare UPIN