Provider Demographics
NPI:1851895098
Name:NGUYEN, DAN PHUONG (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:PHUONG
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:SPRING MILLS MEDICAL OFFICE
Mailing Address - Street 2:61 CAMPUS DR STE 300
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404
Mailing Address - Country:US
Mailing Address - Phone:045-965-1603
Mailing Address - Fax:
Practice Address - Street 1:SPRING MILLS MEDICAL OFFICE
Practice Address - Street 2:61 CAMPUS DR STE 300
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7542
Practice Address - Country:US
Practice Address - Phone:304-596-5160
Practice Address - Fax:304-596-5161
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101275001208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program