Provider Demographics
NPI:1841256559
Name:NGUYEN, PATRICK PHONG (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PHONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:696 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2748
Mailing Address - Country:US
Mailing Address - Phone:603-429-3155
Mailing Address - Fax:603-424-8693
Practice Address - Street 1:399 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4112
Practice Address - Country:US
Practice Address - Phone:603-429-3155
Practice Address - Fax:603-424-8693
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14089207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708039Medicaid
080127022OtherPALMETTO
PA975072OtherBS
51393001OtherUNIVERA
PA110474OtherUNLSON
PA975072OtherBS
PA118477D6JMedicare ID - Type Unspecified