Healthcare Provider Details

I. General information

NPI: 1578663290
Provider Name (Legal Business Name): THUANHANH T. NGUYEN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 EMERYWOOD DR STE D
CHARLOTTE NC
28210-4105
US

IV. Provider business mailing address

PO BOX 240296
CHARLOTTE NC
28224-0296
US

V. Phone/Fax

Practice location:
  • Phone: 704-554-8880
  • Fax: 704-554-8883
Mailing address:
  • Phone: 704-554-8880
  • Fax: 704-554-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200201583
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9901337
License Number StateNC

VIII. Authorized Official

Name: DR. THUANHANH THI NGUYEN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 704-554-8880