Provider Demographics
NPI:1639175789
Name:NGUYEN, DUY B (MD)
Entity Type:Individual
Prefix:
First Name:DUY
Middle Name:B
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 1:169 SOUTH MOUNT VERNON AVEUNE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-438-3524
Mailing Address - Fax:724-438-5218
Practice Address - Street 1:169 SOUTH MOUNT VERNON AVEUNE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-438-3524
Practice Address - Fax:724-438-5218
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055663L208000000X
PAMD0556631L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP001201OtherGATEWAY HEALTH PLAN
PA784875OtherHIGHMARK
PA0015323380002Medicaid
PA61666OtherTHREE RIVERS HEALTH PLAN
PA1133690OtherUPMC HEALTH PLAN
PA370020177OtherRAILROAD MEDICARE
PAP001201OtherGATEWAY HEALTH PLAN
PA1133690OtherUPMC HEALTH PLAN
PA784875Medicare ID - Type Unspecified