Provider Demographics
NPI:1851931430
Name:NGUYEN, OCEAN NGOC (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:OCEAN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1745
Mailing Address - Country:US
Mailing Address - Phone:978-851-4683
Mailing Address - Fax:978-710-5054
Practice Address - Street 1:345 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1745
Practice Address - Country:US
Practice Address - Phone:978-851-4683
Practice Address - Fax:978-710-5054
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8277363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant