Provider Demographics
NPI:1629053046
Name:NGUYEN, HIEN QUANG (MD)
Entity Type:Individual
Prefix:
First Name:HIEN
Middle Name:QUANG
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 1:101 CHESAPEAKE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6607
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:410-392-4524
Practice Address - Street 1:379 WALMART DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1365
Practice Address - Country:US
Practice Address - Phone:302-387-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057210208600000X
DEC1-0011106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406917000Medicaid
MD406917000Medicaid
H42209Medicare UPIN