Provider Demographics
NPI:1508938093
Name:VO, LUONG VAN (MD)
Entity Type:Individual
Prefix:
First Name:LUONG
Middle Name:VAN
Last Name:VO
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 1:228 CHELTENHAM LN
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1762
Mailing Address - Country:US
Mailing Address - Phone:330-630-1249
Mailing Address - Fax:
Practice Address - Street 1:9424 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5226
Practice Address - Country:US
Practice Address - Phone:330-626-3455
Practice Address - Fax:330-626-4189
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870615Medicaid
OH0870615Medicaid
OHVO7257151Medicare ID - Type Unspecified