Provider Demographics
NPI:1730356619
Name:AMARALIKIT, PHETPAILIN (MD)
Entity type:Individual
Prefix:
First Name:PHETPAILIN
Middle Name:
Last Name:AMARALIKIT
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 1:420 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4511
Mailing Address - Country:US
Mailing Address - Phone:571-353-1899
Mailing Address - Fax:888-974-1477
Practice Address - Street 1:420 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4511
Practice Address - Country:US
Practice Address - Phone:571-353-1899
Practice Address - Fax:888-974-1477
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine