Provider Demographics
NPI:1942248117
Name:NGUYEN, BEN L (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:L
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:#330
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4625
Mailing Address - Country:US
Mailing Address - Phone:703-876-4270
Mailing Address - Fax:703-876-4276
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:#330
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4625
Practice Address - Country:US
Practice Address - Phone:703-876-4270
Practice Address - Fax:703-876-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059150174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006105572Medicaid
VA226790OtherANTHEM PROVIDER #
DC5314OtherCARE FIRST BCBS PROV #
VAG87141Medicare UPIN
VA490285Medicare PIN