Healthcare Provider Details

I. General information

NPI: 1336677863
Provider Name (Legal Business Name): DUY DUC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

26 QUEEN ST
WORCESTER MA
01610-2478
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7800
  • Fax: 508-860-7865
Mailing address:
  • Phone: 508-860-7800
  • Fax: 508-860-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number285811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: