Provider Demographics
NPI:1366019499
Name:NGUYEN, DUY THANH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DUY
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2120
Mailing Address - Country:US
Mailing Address - Phone:240-205-1949
Mailing Address - Fax:
Practice Address - Street 1:14107 BAUER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2120
Practice Address - Country:US
Practice Address - Phone:240-205-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical