Provider Demographics
NPI:1942320544
Name:HIEP D. NGUYEN, M.D., P.C
Entity Type:Organization
Organization Name:HIEP D. NGUYEN, M.D., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEP
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-453-5552
Mailing Address - Street 1:576 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3911
Mailing Address - Country:US
Mailing Address - Phone:978-453-5552
Mailing Address - Fax:978-453-5015
Practice Address - Street 1:576 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3911
Practice Address - Country:US
Practice Address - Phone:978-453-5552
Practice Address - Fax:978-453-5015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL PROVIDER SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15767OtherBLUECROSS BLUESHIELD
MA9770003Medicaid
MAM15767Medicare ID - Type Unspecified