Provider Demographics
NPI:1275585473
Name:NGUYEN, JANE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:TRANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-723-9751
Mailing Address - Fax:703-723-9752
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-723-9751
Practice Address - Fax:703-723-9752
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239929207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH79413Medicare UPIN