Provider Demographics
NPI:1144542291
Name:NGUYEN, PHUC L (MD)
Entity type:Individual
Prefix:
First Name:PHUC
Middle Name:L
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 1:1322 RHODE ISLAND AVE NW
Mailing Address - Street 2:APT 7
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3739
Mailing Address - Country:US
Mailing Address - Phone:617-605-9116
Mailing Address - Fax:
Practice Address - Street 1:4151 BLADENSBURG RD
Practice Address - Street 2:
Practice Address - City:COLMAR MANOR
Practice Address - State:MD
Practice Address - Zip Code:20722-1928
Practice Address - Country:US
Practice Address - Phone:301-699-7700
Practice Address - Fax:301-779-9001
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program