Provider Demographics
NPI:1083648430
Name:MA, NGUON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NGUON
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8701 -D WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082
Mailing Address - Country:US
Mailing Address - Phone:610-734-0610
Mailing Address - Fax:610-734-0874
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-2531
Practice Address - Fax:610-237-2553
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA000640L/QA000506L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant