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General NPI Number Information
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NPI Number | 1548553696
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Entity Type | Organization
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Legal Business Name | THE 02 ZONE LLC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 1840 AMHERST ST
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City | WINCHESTER
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State | VA
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Zip | 22601-2808
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Country | US
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Telephone | 540-536-6547
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Fax | 540-536-4277
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Provider Business Mailing Address
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Address Line | 136 LINDEN DR SUITE 104
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City | WINCHESTER
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State | VA
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Zip | 22601-6900
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Country | US
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Telephone | 540-678-3588
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Fax | 540-678-9025
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Authorized Official
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Title or Position | OWNER
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Name | THAI Q NGUYEN
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Credential | MD
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Telephone | 540-536-6547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number |
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License Number State | VA
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