Healthcare Provider Details

I. General information

NPI: 1962599688
Provider Name (Legal Business Name): VINH TRONG NGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 S BABCOCK STREET
MELBOURNE FL
32901
US

IV. Provider business mailing address

2575 NORTH COURTENAY PKWY
MERRITT ISLAND FL
32953
US

V. Phone/Fax

Practice location:
  • Phone: 321-726-2920
  • Fax: 321-726-2916
Mailing address:
  • Phone: 321-454-7148
  • Fax: 321-449-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME49832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: