Provider Demographics
NPI:1083674659
Name:VU, DANG H (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANG
Middle Name:H
Last Name:VU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLYNDON DR
Mailing Address - Street 2:STE 2A
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2000
Mailing Address - Country:US
Mailing Address - Phone:410-833-2255
Mailing Address - Fax:410-833-9211
Practice Address - Street 1:4 GLYNDON DR
Practice Address - Street 2:STE 2A
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2000
Practice Address - Country:US
Practice Address - Phone:410-833-2255
Practice Address - Fax:410-833-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01288213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404184400Medicaid
MD613874-08OtherBLUECROSS BLUESHIELD
MD404184400Medicaid
MD5733540001Medicare NSC
MD613874-08OtherBLUECROSS BLUESHIELD
MD280P586GMedicare PIN