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General NPI Number Information
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NPI Number | 1609858018
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Entity Type | Individual
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Provider Name | DIEM D NGUYEN MD
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Gender | Male
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | EASTERN STATE HOSPITAL 4601 IRONBOUND RD.
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City | WILLIAMSBURG
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State | VA
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Zip | 23187-8791
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Country | US
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Telephone | 757-253-7434
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Fax | 757-253-4564
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Provider Business Mailing Address
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Address Line | 3024 WHITTAKER ISLAND RD
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-7669
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Country | US
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Telephone | 757-253-6531
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | VA01010411157
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License Number State | VA
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