Healthcare Provider Details

I. General information

NPI: 1548985047
Provider Name (Legal Business Name): ANH NGOC TRAM NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N
LARGO MD
20774-5477
US

IV. Provider business mailing address

901 HARRY S TRUMAN DR N
LARGO MD
20774-5477
US

V. Phone/Fax

Practice location:
  • Phone: 240-677-0021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008662
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: