Provider Demographics
NPI:1306979729
Name:NGUYEN, KHIET T (MD)
Entity type:Individual
Prefix:
First Name:KHIET
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUIE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:301-460-0199
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 620
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-530-6646
Practice Address - Fax:301-530-0773
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD643472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANPIMedicaid
NPIOtherMEDICARE
P00644589OtherRAILROAD MEDICARE
NPIOtherMEDICARE - FREDERICK, MD REGION
MD415144500Medicaid