Healthcare Provider Details

I. General information

NPI: 1093274839
Provider Name (Legal Business Name): MICHAEL NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST. NW DEPARTMENT OF EMERGENCY MEDICINE
WASHINGTON DC
20010
US

IV. Provider business mailing address

110 IRVING ST. NW DEPARTMENT OF EMERGENCY MEDICINE
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8080
  • Fax: 202-877-7633
Mailing address:
  • Phone: 202-877-8080
  • Fax: 202-877-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0094938
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101275209
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberCS210126228
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: