MEDICARE: DR. THUANHANH THI NGUYEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200101583	NC
2	207R00000X	Internal Medicine Physician	47629	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285622407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUANHANH THI NGUYEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 240296
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28224-0296
Country	:	US
Telephone Number	:	704-904-6653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 EMERYWOOD DR
Second Line	:	STE D
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4105
Country	:	US
Telephone Number	:	704-554-8880
Fax Number	:	704-554-8883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/06/2010

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