| Vienna Dermatology, Llc | |
|
410 Maple Ave W Ste 3 Vienna VA 22180-4224 | |
| (703) 281-3626 | |
| (703) 281-3615 |
| Full Name | Vienna Dermatology, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 410 Maple Ave W Ste 3, Vienna, Virginia |
| Authorized Official Name and Position | Mai Hoang Nguyen (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7032813626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vienna Dermatology, Llc 410 Maple Ave W Ste 3 Vienna VA 22180-4224 Ph: (703) 281-3626 | Vienna Dermatology, Llc 410 Maple Ave W Ste 3 Vienna VA 22180-4224 Ph: (703) 281-3626 |
| NPI Number | 1689076747 |
|---|---|
| Provider Enumeration Date | 09/20/2014 |
| Last Update Date | 09/20/2014 |
| Medicare PECOS PAC ID | 3173957636 |
|---|---|
| Medicare Enrollment ID | O20191217001092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689076747 | NPI | - | NPPES |
| 00A948510 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0101244058 (Virginia) | Primary |
| Provider Name | Mai Hoang Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275612319 PECOS PAC ID: 3173525441 Enrollment ID: I20091216000527 |
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