Healthcare Provider Details

I. General information

NPI: 1700817525
Provider Name (Legal Business Name): ANHTAI H NGUYEN MD,MBA,FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 OPAL CT
HAGERSTOWN MD
21740-5940
US

IV. Provider business mailing address

1138 OPAL CT
HAGERSTOWN MD
21740-5940
US

V. Phone/Fax

Practice location:
  • Phone: 301-745-5224
  • Fax: 301-745-4616
Mailing address:
  • Phone: 301-745-5224
  • Fax: 301-745-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0056023
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0056023
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: