Provider Demographics
NPI:1699851139
Name:NGUYEN, HIEP DINH (MD)
Entity Type:Individual
Prefix:DR
First Name:HIEP
Middle Name:DINH
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 1:576 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3911
Mailing Address - Country:US
Mailing Address - Phone:978-453-5552
Mailing Address - Fax:978-453-5015
Practice Address - Street 1:576 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3911
Practice Address - Country:US
Practice Address - Phone:978-453-5552
Practice Address - Fax:978-453-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
043198357OtherEMPLOYER TAX ID
MA0185833Medicaid
MA0185833Medicaid
043198357OtherEMPLOYER TAX ID