Provider Demographics
NPI:1841342144
Name:DUONG, PHUONG-ANH T (MD)
Entity type:Individual
Prefix:
First Name:PHUONG-ANH
Middle Name:T
Last Name:DUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OHIO DR.
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-222-2022
Mailing Address - Fax:516-730-2081
Practice Address - Street 1:6 OHIO DR.
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-222-2022
Practice Address - Fax:516-730-2081
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012378962085R0202X
NY3194952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010176221Medicaid
VAI03394Medicare UPIN