MEDICARE: DR. BACH VAN NGUYEN M.D.

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
1	207Q00000X	Family Medicine Physician	MD-039485L	PA
2	207R00000X	Internal Medicine Physician	MD-039485L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001123542	OTHER	PA	MEDICAL ASSISTANCE

General Provider Information

NPI Number	:	1114923869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BACH VAN NGUYEN M.D.

Provider Business Mailing Address
First Line	:	30 OLD STATE RD
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-1125
Country	:	US
Telephone Number	:	610-688-3184
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2310
Country	:	US
Telephone Number	:	215-755-8220
Fax Number	:	215-755-8692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/22/2016

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