Healthcare Provider Details

I. General information

NPI: 1811494263
Provider Name (Legal Business Name): SUONG T NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PRESCOTT ST STE 302
WORCESTER MA
01605-2610
US

IV. Provider business mailing address

85 PRESCOTT ST STE 302
WORCESTER MA
01605-2610
US

V. Phone/Fax

Practice location:
  • Phone: 774-420-2642
  • Fax: 774-420-2283
Mailing address:
  • Phone: 774-420-2611
  • Fax: 774-420-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1028368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: