Provider Demographics
NPI:1700570355
Name:NGUYEN, NAM (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 STILLWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1650
Mailing Address - Country:US
Mailing Address - Phone:315-247-6506
Mailing Address - Fax:
Practice Address - Street 1:108 STILLWATER DRIVE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1650
Practice Address - Country:US
Practice Address - Phone:315-247-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant