Provider Demographics
NPI:1922672849
Name:NITHAGON, PICHAYUT (MD)
Entity type:Individual
Prefix:MR
First Name:PICHAYUT
Middle Name:
Last Name:NITHAGON
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 1:3400 SPRUCE STREET
Mailing Address - Street 2:7.055 GATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-6550
Mailing Address - Fax:215-615-3931
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:7.055 GATES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-6550
Practice Address - Fax:215-615-3931
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program