Provider Demographics
NPI:1649598715
Name:XIE, DONGHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:DONGHUA
Middle Name:
Last Name:XIE
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 1:5605 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1531
Mailing Address - Country:US
Mailing Address - Phone:954-854-9429
Mailing Address - Fax:
Practice Address - Street 1:5605 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1531
Practice Address - Country:US
Practice Address - Phone:954-854-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2019-08-15
Deactivation Date:2019-08-10
Deactivation Code:
Reactivation Date:2019-08-15
Provider Licenses
StateLicense IDTaxonomies
FLME128203208800000X
MI4301104126208800000X, 390200000X
NC00272208800000X
NYP86611390200000X
IL125060697390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program