Provider Demographics
NPI:1619913175
Name:NGO, HUAN T (MD)
Entity Type:Individual
Prefix:
First Name:HUAN
Middle Name:T
Last Name:NGO
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 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7400
Mailing Address - Fax:508-941-6200
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 3250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-7123
Practice Address - Fax:866-284-7123
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220629207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200283Medicaid
MAA37125Medicare ID - Type UnspecifiedINDIVIDUAL
MA1200283Medicaid