Healthcare Provider Details

I. General information

NPI: 1851895098
Provider Name (Legal Business Name): DAN PHUONG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPRING MILLS MEDICAL OFFICE 61 CAMPUS DR STE 300
MARTINSBURG WV
25404-7542
US

IV. Provider business mailing address

SPRING MILLS MEDICAL OFFICE 61 CAMPUS DR STE 300
MARTINSBURG WV
25404
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5160
  • Fax: 304-596-5161
Mailing address:
  • Phone: 45-965-1603
  • 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 Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101275001
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: