Provider Demographics
NPI:1194443242
Name:HO, MACHCUONG (MSN, APRN, FNP-BC/C)
Entity type:Individual
Prefix:MR
First Name:MACHCUONG
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC/C
Other - Prefix:
Other - First Name:DAVID MACHCUONG
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN, FNP-BC/C
Mailing Address - Street 1:294 N MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1879
Mailing Address - Country:US
Mailing Address - Phone:413-224-1009
Mailing Address - Fax:
Practice Address - Street 1:294 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1838
Practice Address - Country:US
Practice Address - Phone:413-224-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000000363LP2300X
MARN2334832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2334832OtherAESTHETIC MEDICINE, MENS HEALTH