Provider Demographics
NPI:1689691453
Name:GOODAHL, NGA NGUYEN (DO)
Entity Type:Individual
Prefix:DR
First Name:NGA
Middle Name:NGUYEN
Last Name:GOODAHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 9TH ST N
Mailing Address - Street 2:# 723
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1956
Mailing Address - Country:US
Mailing Address - Phone:956-459-6161
Mailing Address - Fax:
Practice Address - Street 1:301 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-3045
Practice Address - Country:US
Practice Address - Phone:956-632-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170841-1174400000X
TXJ1673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF36297Medicare UPIN