Healthcare Provider Details

I. General information

NPI: 1003367335
Provider Name (Legal Business Name): RICHARD DUONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIBERTY ST
BROCKTON MA
02301
US

IV. Provider business mailing address

110 LIBERTY ST
BROCKTON MA
02301-5674
US

V. Phone/Fax

Practice location:
  • Phone: 508-565-3055
  • Fax:
Mailing address:
  • Phone: 508-565-3055
  • Fax: 508-894-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5946
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: