Provider Demographics
NPI:1467879627
Name:NGUYEN, DU VAN (MD)
Entity Type:Individual
Prefix:
First Name:DU
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1150
Mailing Address - Country:US
Mailing Address - Phone:585-593-7911
Mailing Address - Fax:585-593-7913
Practice Address - Street 1:191 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1150
Practice Address - Country:US
Practice Address - Phone:585-593-7911
Practice Address - Fax:585-593-7913
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283549208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000545382001OtherBCBS
NY04379237Medicaid
NY190805000012OtherFIDELIS
NY000000376705OtherUNIVERA
NY11083030OtherINDEPENDENT HEALTH