Provider Demographics
NPI:1215377999
Name:NGUYEN, EMILY ROE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SPRUCE ST BSMT WEST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4022
Mailing Address - Country:US
Mailing Address - Phone:215-829-3264
Mailing Address - Fax:215-829-8044
Practice Address - Street 1:700 SPRUCE ST BSMT WEST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4022
Practice Address - Country:US
Practice Address - Phone:215-829-3264
Practice Address - Fax:215-829-8044
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD476002207P00000X
MI4301102807207P00000X
NC2016-00776207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine