Provider Demographics
NPI:1720139496
Name:NGUYEN, TRONG V (MD)
Entity Type:Individual
Prefix:DR
First Name:TRONG
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HARRISON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1924
Mailing Address - Country:US
Mailing Address - Phone:617-423-9088
Mailing Address - Fax:617-423-7332
Practice Address - Street 1:65 HARRISON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1924
Practice Address - Country:US
Practice Address - Phone:617-423-9088
Practice Address - Fax:617-423-7332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAN3244263208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA53654OtherMASS. LICENSE NUMBER
MAMN0206981ATOtherSTATE CONTROL SYSTEM #
MAB97870OtherPIN
MAB97870OtherPIN
MAAN3244263OtherDEA#