Provider Demographics
NPI:1588640858
Name:DANG, THUAN DUC (MD)
Entity Type:Individual
Prefix:
First Name:THUAN
Middle Name:DUC
Last Name:DANG
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:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-629-1463
Mailing Address - Fax:410-641-9573
Practice Address - Street 1:29 BROAD STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-1463
Practice Address - Fax:410-641-9573
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401771400Medicaid
MDH84624Medicare UPIN
MD401771400Medicaid