Provider Demographics
NPI:1427206093
Name:NGUYEN, THERESA THU THAO (DO)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:THU THAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BEEKMAN PL NW
Mailing Address - Street 2:APT B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4000
Mailing Address - Country:US
Mailing Address - Phone:415-846-0393
Mailing Address - Fax:
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:SUITE 412
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-770-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051600207W00000X
NY256836-1207W00000X
MDH0073311207W00000X
DCDO034365207W00000X
VA0102202992207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology