Provider Demographics
NPI:1467402370
Name:NGUYEN, HONGHANH LISA (MD)
Entity Type:Individual
Prefix:
First Name:HONGHANH
Middle Name:LISA
Last Name:NGUYEN
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 1:1509 LAKE NORWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-3004
Mailing Address - Country:US
Mailing Address - Phone:301-924-9025
Mailing Address - Fax:
Practice Address - Street 1:11016 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2612
Practice Address - Country:US
Practice Address - Phone:301-681-3300
Practice Address - Fax:301-681-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052961207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699532200Medicaid
MD699532200Medicaid
MDG81019Medicare UPIN