Provider Demographics
NPI:1215927629
Name:DANG, DIEMNGOC T (MD)
Entity type:Individual
Prefix:
First Name:DIEMNGOC
Middle Name:T
Last Name:DANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15500 CHICACOAN DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6109
Mailing Address - Country:US
Mailing Address - Phone:703-498-8659
Mailing Address - Fax:703-730-1198
Practice Address - Street 1:4710 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9433
Practice Address - Country:US
Practice Address - Phone:540-741-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010162645Medicaid
VA010162645Medicaid