Provider Demographics
NPI:1932318490
Name:NGUYEN, THAO VAN THI (MD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:VAN THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:240-654-4683
Mailing Address - Fax:240-654-4696
Practice Address - Street 1:15200 SHADY GROVE RD 205
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6228
Practice Address - Country:US
Practice Address - Phone:240-654-4683
Practice Address - Fax:240-654-4696
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068587207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology