Provider Demographics
NPI:1831108752
Name:NGUYEN, TRACH N (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACH
Middle Name:N
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 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE #350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048156207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK142-0001OtherCARE FIRST
VA136914OtherANTHEM
VA136914OtherTRIGON
VA4526-8633OtherCARE FIRST
VA293724OtherAMERIGROUP
VA484645OtherNCPPO
VA1831108752Medicaid
VAP00110939OtherRAILROAD MEDICARE
DC013329F39Medicare PIN
VA009506F81Medicare PIN
VA484645OtherNCPPO