Pongtawat Lertwilaiwittaya, MD
Medical Genetics, Clinical Genetics (M.D.) in Birmingham, AL. Individual provider (NPI-1).
NPI number1619546751
StatusActive
Last updated in NPPESJul 25, 2025
Details
- NPI
- 1619546751
- Entity type
- Individual (NPI-1)
- Name
- Pongtawat Lertwilaiwittaya
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 23, 2021
- Certification date
- Jul 25, 2025
- Last updated
- Jul 25, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - MEDICAL GENETICS AND GENOMICS
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207SG0201X | Medical Genetics, Clinical Genetics (M.D.) | 47930 | AL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
625 19th St SBirmingham, AL 35233-1900
Phone 205-934-9666
Mailing address
625 19th St SBirmingham, AL 35233-1900
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