Provider Demographics
NPI:1639123938
Name:NGUYEN, THIEN TUONG (MD)
Entity Type:Individual
Prefix:
First Name:THIEN
Middle Name:TUONG
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 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:240-477-5973
Mailing Address - Fax:301-519-0279
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-477-5973
Practice Address - Fax:301-519-0279
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD622402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406141100Medicaid
MDI22146Medicare UPIN
DC296494YTD0Medicare PIN