Provider Demographics
NPI:1699938423
Name:NGUYEN, HARRISON (MD)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:
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 1:9506B LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2303
Mailing Address - Country:US
Mailing Address - Phone:571-279-0409
Mailing Address - Fax:703-273-2038
Practice Address - Street 1:9506B LEE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2303
Practice Address - Country:US
Practice Address - Phone:571-279-0409
Practice Address - Fax:703-273-2038
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0385522084P0800X
CAA1018212084P0800X
VA01012487472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry