Provider Demographics
NPI:1477660983
Name:NGUYEN, TUAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:TUAN
Middle Name:G
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 1:22 LLANFAIR RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2320
Mailing Address - Country:US
Mailing Address - Phone:712-363-9064
Mailing Address - Fax:
Practice Address - Street 1:22 LLANFAIR RD UNIT 6
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2320
Practice Address - Country:US
Practice Address - Phone:712-363-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH64722085R0202X
FLTPME45702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPME4570OtherLICENSE
TXH6472OtherLICENSE