Healthcare Provider Details

I. General information

NPI: 1639175789
Provider Name (Legal Business Name): DUY B NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SOUTH MOUNT VERNON AVEUNE
UNIONTOWN PA
15401
US

IV. Provider business mailing address

169 SOUTH MOUNT VERNON AVEUNE
UNIONTOWN PA
15401
US

V. Phone/Fax

Practice location:
  • Phone: 724-438-3524
  • Fax: 724-438-5218
Mailing address:
  • Phone: 724-438-3524
  • Fax: 724-438-5218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD055663L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0556631L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP001201
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN
# 2
Identifier784875
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 3
Identifier0015323380002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier61666
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS HEALTH PLAN
# 5
Identifier1133690
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC HEALTH PLAN
# 6
Identifier370020177
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: