Provider Demographics
NPI:1972637015
Name:NGUYEN, THUC TRI (DC)
Entity Type:Individual
Prefix:DR
First Name:THUC
Middle Name:TRI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 BROOKFIELD PLZ
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-8000
Mailing Address - Country:US
Mailing Address - Phone:703-395-8057
Mailing Address - Fax:
Practice Address - Street 1:30283 TRIANGLE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3125
Practice Address - Country:US
Practice Address - Phone:301-472-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556077111N00000X
MD20969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA437289OtherANTHEM BLUE CROSS BLUE SH
CA1042533OtherASH
VA0300683Medicaid
PA1042723OtherCIGNA
PA1042723OtherCIGNA