1396894598 NPI number — DR. THUY-LINH DUY NGUYEN D.P.M.

Table of content: CHARLES ALAN MATLACH (NPI 1306859483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396894598 NPI number — DR. THUY-LINH DUY NGUYEN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
THUY-LINH
Provider Middle Name:
DUY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
LINH
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396894598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3334 PAPER MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21131-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-666-3668
Provider Business Mailing Address Fax Number:
410-666-3669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 PAPER MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21131-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-666-3668
Provider Business Practice Location Address Fax Number:
410-666-3669
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  01455 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 01455 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01012727 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 002812827 . This is a "UHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7024957 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 216899 . This is a "CIGNA HEALTHSPRINGS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: V897 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 432505200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2333808 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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