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General NPI Number Information
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NPI Number | 1831186535
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Entity Type | Individual
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Provider Name | NGUYEN VIET TA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 1433 EMERYWOOD DR STE D
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City | CHARLOTTE
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State | NC
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Zip | 28210-4105
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Country | US
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Telephone | 704-554-8880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 240296
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City | CHARLOTTE
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State | NC
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Zip | 28224-0296
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Country | US
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Telephone | 704-554-8880
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Fax | 704-554-8880
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9901337
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License Number State | NC
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