Healthcare Provider Details

I. General information

NPI: 1023143195
Provider Name (Legal Business Name): BAO-NGOC HUONG NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW STE 6B-412A
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-4089
  • Fax: 410-328-5919
Mailing address:
  • Phone: 202-741-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD039878
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: