Provider Demographics
NPI:1780686444
Name:NGUYEN, QUAN QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:QUAN
Middle Name:QUOC
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 1:4217 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3210
Mailing Address - Country:US
Mailing Address - Phone:703-354-2629
Mailing Address - Fax:703-941-2918
Practice Address - Street 1:4217 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3210
Practice Address - Country:US
Practice Address - Phone:703-354-2629
Practice Address - Fax:703-941-2918
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA408767Medicare PIN
VAD66446Medicare UPIN