Provider Demographics
NPI:1215039391
Name:CHIEU, TON THAT (MD)
Entity Type:Individual
Prefix:DR
First Name:TON
Middle Name:THAT
Last Name:CHIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHIEU
Other - Middle Name:THAT
Other - Last Name:TON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7505 NEW HAMPSHIRE AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6972
Mailing Address - Country:US
Mailing Address - Phone:301-445-4100
Mailing Address - Fax:301-445-2167
Practice Address - Street 1:7505 NEW HAMPSHIRE AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6972
Practice Address - Country:US
Practice Address - Phone:301-445-4100
Practice Address - Fax:301-445-2167
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023429208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
417637Medicare ID - Type Unspecified
C62689Medicare UPIN