MEDICARE: THUANHANH T. NGUYEN, M.D., P.A.

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	208000000X	Pediatrics Physician	9901337	NC
2	207R00000X	Internal Medicine Physician	200201583	NC

General Provider Information

NPI Number	:	1578663290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THUANHANH T. NGUYEN, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 240296
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28224-0296
Country	:	US
Telephone Number	:	704-554-8880
Fax Number	:	704-554-8883

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	:	PRESIDENT/OWNER
Name	:	DR. THUANHANH THI NGUYEN
Credential	:	M.D.
Telephone Number	:	704-554-8880

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	11/15/2011

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