Healthcare Provider Details

I. General information

NPI: 1609940287
Provider Name (Legal Business Name): LINH NGUYEN O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 COURT DR STE 450
GASTONIA NC
28054-2191
US

IV. Provider business mailing address

2555 COURT DR STE 450
GASTONIA NC
28054-2191
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-7652
  • Fax: 704-671-7656
Mailing address:
  • Phone: 704-671-7652
  • Fax: 704-671-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017-01424
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036093594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: