=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083674659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANG H. VU D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2006
-----------------------------------------------------
Last Update Date | 09/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 GLYNDON DR STE 2A
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-833-2255
-----------------------------------------------------
Fax | 410-833-9211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 GLYNDON DR STE 2A
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-833-2255
-----------------------------------------------------
Fax | 410-833-9211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 01288
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------