Individual provider · Type 1 NPI

Pornlada Likasitwatanakul, MD

Student in an Organized Health Care Education/Training Program · Boston, MA

NPI number 1558057117 Active

Practice location

330 Brookline Ave
Boston, MA 02215-5491

Call (617) 667-2131 Map

Fax (617) 667-3915

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000X3019763 (MA)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1558057117

Pornlada Likasitwatanakul, MD's National Provider Identifier is 1558057117, issued on Apr 14, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Boston, MA. The record was last updated on Jun 21, 2026.