Provider Demographics
NPI:1700817525
Name:NGUYEN, ANHTAI H (MD,MBA,FACS)
Entity Type:Individual
Prefix:
First Name:ANHTAI
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD,MBA,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5940
Mailing Address - Country:US
Mailing Address - Phone:301-745-5224
Mailing Address - Fax:301-745-4616
Practice Address - Street 1:1138 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:301-745-5224
Practice Address - Fax:301-745-4616
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00560232086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113205900Medicaid
MDH23955Medicare UPIN
MD930M735FMedicare ID - Type Unspecified