Provider Demographics
NPI:1306015227
Name:HOANG, MARY THERESA VU (MD)
Entity Type:Individual
Prefix:
First Name:MARY THERESA
Middle Name:VU
Last Name:HOANG
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 1:607 TIMBERDALE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3049
Mailing Address - Country:US
Mailing Address - Phone:281-440-3005
Mailing Address - Fax:281-444-9070
Practice Address - Street 1:607 TIMBERDALE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3049
Practice Address - Country:US
Practice Address - Phone:281-440-3005
Practice Address - Fax:281-444-9070
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8042207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196278901Medicaid
TX8F6675OtherBCBSTX
TXTXB131385Medicare PIN
8K7852Medicare PIN