Healthcare Provider Details

I. General information

NPI: 1578828810
Provider Name (Legal Business Name): NICOLE NGUYEN PERRAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE NGUYEN

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW SUITE 200
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

2115 WISCONSIN AVE NW SUITE 200
WASHINGTON DC
20007-2265
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone: 240-428-4834
  • Fax: 202-944-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD041975
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: