Healthcare Provider Details

I. General information

NPI: 1861029340
Provider Name (Legal Business Name): SAMANTHA MINH THY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

8401 CONNECTICUT AVE STE 450
CHEVY CHASE MD
20815-5805
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2227
  • Fax: 434-243-7288
Mailing address:
  • Phone: 301-453-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberH0102974
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: