Provider Demographics
NPI:1033162482
Name:NGUYEN, DIEN (MD)
Entity Type:Individual
Prefix:
First Name:DIEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4951
Mailing Address - Country:US
Mailing Address - Phone:540-736-5043
Mailing Address - Fax:540-736-5044
Practice Address - Street 1:3031 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4951
Practice Address - Country:US
Practice Address - Phone:540-736-5043
Practice Address - Fax:540-736-5044
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
363674OtherANTHEM BLUE CROSS AND BLUE SHIELD OF VIRGINIA
VAVVA628AMedicare PIN
I49567Medicare UPIN