MEDICARE: DR. TRONG V 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	208D00000X	General Practice Physician	AN3244263	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53654	OTHER	MA	MASS. LICENSE NUMBER
2	MN0206981AT	OTHER	MA	STATE CONTROL SYSTEM #
3	B97870	OTHER	MA	PIN

General Provider Information

NPI Number	:	1720139496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRONG V NGUYEN MD

Provider Business Mailing Address
First Line	:	65 HARRISON AVE
Second Line	:	SUITE 308
City	:	BOSTON
State	:	MA
Zip	:	02111-1924
Country	:	US
Telephone Number	:	617-423-9088
Fax Number	:	617-423-7332

Provider Business Practice Location Address
First Line	:	65 HARRISON AVE
Second Line	:	SUITE 308
City	:	BOSTON
State	:	MA
Zip	:	02111-1924
Country	:	US
Telephone Number	:	617-423-9088
Fax Number	:	617-423-7332

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	03/07/2023

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