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General NPI Number Information
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NPI Number | 1003391087
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Entity Type | Individual
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Provider Name | ANDREW NGUYEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 1400 VFW PKWY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone | 508-682-1432
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 VFW PKWY SURGICAL SUITE 112, NEUROSURGERY
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01086
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA01086
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License Number State | RI
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