MEDICARE: DR. PHONG QUANG NGUYEN MD

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	207RR0500X	Rheumatology Physician	0101036868	VA

General Provider Information

NPI Number	:	1699836726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHONG QUANG NGUYEN MD

Provider Business Mailing Address
First Line	:	1860 TOWN CENTER DR STE 130
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-5898
Country	:	US
Telephone Number	:	703-709-9174
Fax Number	:	703-709-9183

Provider Business Practice Location Address
First Line	:	1860 TOWN CENTER DR STE 130
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-5898
Country	:	US
Telephone Number	:	703-709-9174
Fax Number	:	703-709-9183

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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