MEDICARE: MAI TAI 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	207RH0003X	Hematology & Oncology Physician	54685	MA

General Provider Information

NPI Number	:	1316088438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI TAI NGUYEN M.D.

Provider Business Mailing Address
First Line	:	186 BEACON ST
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-2813
Country	:	US
Telephone Number	:	978-686-9152
Fax Number	:	978-794-3516

Provider Business Practice Location Address
First Line	:	411 MERRIMACK ST
Second Line	:	SUITE 203
City	:	METHUEN
State	:	MA
Zip	:	01844-5821
Country	:	US
Telephone Number	:	978-686-9152
Fax Number	:	978-794-3516

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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