Provider Demographics
NPI:1568808814
Name:NGUYEN, QUOC VAN (MD)
Entity Type:Individual
Prefix:
First Name:QUOC
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 1:4810 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9348
Mailing Address - Country:US
Mailing Address - Phone:315-247-2990
Mailing Address - Fax:315-435-5720
Practice Address - Street 1:4810 PALMER RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9348
Practice Address - Country:US
Practice Address - Phone:315-247-2990
Practice Address - Fax:315-435-5720
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1898942080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases