Provider Demographics
NPI:1275236119
Name:DUONG, MARISA NHAT-QUYNH (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:NHAT-QUYNH
Last Name:DUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:QUYNH
Other - Middle Name:NHAT
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8801 BEAUCHAMP DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2613
Mailing Address - Country:US
Mailing Address - Phone:703-678-8263
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0003
Practice Address - Country:US
Practice Address - Phone:336-716-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program