Provider Demographics
NPI:1578928040
Name:BACH VAN NGUYEN, M.D, P.C.
Entity Type:Organization
Organization Name:BACH VAN NGUYEN, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BACH
Authorized Official - Middle Name:V
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-755-8220
Mailing Address - Street 1:828 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2310
Mailing Address - Country:US
Mailing Address - Phone:215-755-8220
Mailing Address - Fax:215-755-8692
Practice Address - Street 1:828 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2310
Practice Address - Country:US
Practice Address - Phone:215-755-8220
Practice Address - Fax:215-755-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039485L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPTAN 413645Medicare PIN