Healthcare Provider Details

I. General information

NPI: 1972504777
Provider Name (Legal Business Name): THACH N NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N FRONT ST
WORMLEYSBURG PA
17043-1034
US

IV. Provider business mailing address

1000 N FRONT ST
WORMLEYSBURG PA
17043-1034
US

V. Phone/Fax

Practice location:
  • Phone: 717-731-0101
  • Fax: 717-731-8359
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD034809E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034809E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD034809E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: