Provider Demographics
NPI:1831186535
Name:TA, NGUYEN VIET (MD)
Entity type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:VIET
Last Name:TA
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:PO BOX 240296
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28224-0296
Mailing Address - Country:US
Mailing Address - Phone:704-554-8880
Mailing Address - Fax:704-554-8880
Practice Address - Street 1:1433 EMERYWOOD DR
Practice Address - Street 2:STE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4105
Practice Address - Country:US
Practice Address - Phone:704-554-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics