Healthcare Provider Details

I. General information

NPI: 1083118087
Provider Name (Legal Business Name): THANH MINH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 THOMAS JOHNSON DR STE 202
FREDERICK MD
21702-4374
US

IV. Provider business mailing address

97 THOMAS JOHNSON DR STE 202
FREDERICK MD
21702-4374
US

V. Phone/Fax

Practice location:
  • Phone: 240-873-0009
  • Fax: 240-376-7882
Mailing address:
  • Phone: 240-873-0009
  • Fax: 240-376-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0093710
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: