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NPI Code Detail

MEDICARE: TIN HA NGOC MD

MEDICARE: TIN HA NGOC MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD20742ME

General Provider Information

NPI Number : 1073877791
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIN HA NGOC MD
Provider Business Mailing Address
First Line : PO BOX 9746
Second Line :
City : PORTLAND
State : ME
Zip : 04104-5040
Country : US
Telephone Number : 207-791-3888
Fax Number : 207-828-7850
Provider Business Practice Location Address
First Line : 575 MAIN ST
Second Line :
City : GORHAM
State : ME
Zip : 04038-2623
Country : US
Telephone Number : 207-839-2559
Fax Number : 207-523-1135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2012
Last Update Date : 09/23/2020

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