Provider Demographics
NPI:1679536486
Name:TRINH, PHUONG DUC
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:DUC
Last Name:TRINH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-588-2525
Mailing Address - Fax:301-588-3447
Practice Address - Street 1:8630 FENTON STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-588-2525
Practice Address - Fax:301-588-3447
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025553207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366031100Medicaid
MD089718A45Medicare ID - Type Unspecified
MD366031100Medicaid