Provider Demographics
NPI:1033110754
Name:NGUYEN, THANH G (MD)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:G
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN
Mailing Address - Street 2:STE.285
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-6956
Mailing Address - Fax:412-469-3799
Practice Address - Street 1:100 DELAFIELD ROAD
Practice Address - Street 2:100 MAB- SUITE 212
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-4316
Practice Address - Country:US
Practice Address - Phone:412-784-5144
Practice Address - Fax:412-784-5203
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429530207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016742100001Medicaid
PA1016742100001Medicaid