Provider Demographics
NPI:1174906002
Name:TEERAKANOK, JIRAPAT (MD)
Entity type:Individual
Prefix:
First Name:JIRAPAT
Middle Name:
Last Name:TEERAKANOK
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 1:55 LAKE AVENUE NORTH
Mailing Address - Street 2:RHEUMATOLOGY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:508-856-6246
Mailing Address - Fax:508-856-4770
Practice Address - Street 1:119 BELMONT STREET
Practice Address - Street 2:RHEUMATOLOGY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-334-5224
Practice Address - Fax:508-334-5654
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GUM2365207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program