Provider Demographics
NPI:1265692230
Name:MAI TAI NGUYEN, M.D.
Entity type:Organization
Organization Name:MAI TAI NGUYEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-686-9152
Mailing Address - Street 1:186 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2813
Mailing Address - Country:US
Mailing Address - Phone:978-686-9152
Mailing Address - Fax:
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-686-9152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54685207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J04744OtherBLUE CROSS BLUE SHIELD
J04744OtherMEDICARE ID-TYPE UNSPECIFIED
MAD94110Medicare UPIN