Healthcare Provider Details

I. General information

NPI: 1447284971
Provider Name (Legal Business Name): DR. PHU TAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PHU TAN NGUYEN M.D.

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-3223
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2911
  • Fax: 202-741-2921
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23644
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0095447
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: