Provider Demographics
NPI:1851559223
Name:NGHIEM, WILLIAM XUAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:XUAN
Last Name:NGHIEM
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 1:20410 OBSERVATION DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-3201
Mailing Address - Country:US
Mailing Address - Phone:301-212-4264
Mailing Address - Fax:
Practice Address - Street 1:20410 OBSERVATION DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-3201
Practice Address - Country:US
Practice Address - Phone:301-212-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD781322085R0204X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD546202900Medicaid
MD546202900Medicaid