Healthcare Provider Details

I. General information

NPI: 1063778769
Provider Name (Legal Business Name): DR. QUANG HONG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

2002 MEDICAL PKWY STE 235
ANNAPOLIS MD
21401-3260
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-2770
  • Fax: 410-841-6251
Mailing address:
  • Phone: 410-266-2770
  • Fax: 410-841-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0085967
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0085967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: