Provider Demographics
NPI:1780970814
Name:NGTAM, NGUYEN (MD)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:NGTAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 W BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3927
Mailing Address - Country:US
Mailing Address - Phone:804-655-6008
Mailing Address - Fax:833-428-7575
Practice Address - Street 1:3810 W BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3927
Practice Address - Country:US
Practice Address - Phone:804-655-6008
Practice Address - Fax:833-428-7575
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine