Provider Demographics
NPI:1245334408
Name:TO, VIVIEN NGAH-TSE (MD)
Entity type:Individual
Prefix:
First Name:VIVIEN
Middle Name:NGAH-TSE
Last Name:TO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 KNOLL NORTH DR STE 250
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2368
Mailing Address - Country:US
Mailing Address - Phone:410-964-6200
Mailing Address - Fax:410-964-6392
Practice Address - Street 1:5450 KNOLL NORTH DR STE 250
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2368
Practice Address - Country:US
Practice Address - Phone:410-964-6200
Practice Address - Fax:410-964-6392
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240541207Q00000X
MDD0067576207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417070900Medicaid
D0067576OtherMEDICAL LICENSE