Provider Demographics
NPI:1891727186
Name:VAN NGUYEN, THOMAS THONG (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:THONG
Last Name:VAN NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THONG
Other - Middle Name:VAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4900 BROAD RD
Mailing Address - Street 2:ONONDAGA HILL ACUTE CARE MEDICINE SPECIALIST
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2265
Mailing Address - Country:US
Mailing Address - Phone:315-492-5011
Mailing Address - Fax:
Practice Address - Street 1:8110 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5116
Practice Address - Country:US
Practice Address - Phone:804-320-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236544207Q00000X
VA0101261846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680064Medicaid
NYRB6284Medicare PIN
NY02680064Medicaid
NYRA7517Medicare ID - Type UnspecifiedUPSTATE MEDICARE
NYP00447055Medicare PIN