Provider Demographics
NPI:1053368225
Name:NGO, DUC MINH (MD)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:MINH
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4004 BURKE STATION RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1002
Mailing Address - Country:US
Mailing Address - Phone:703-385-7795
Mailing Address - Fax:703-385-4853
Practice Address - Street 1:4004 BURKE STATION RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1002
Practice Address - Country:US
Practice Address - Phone:703-385-7795
Practice Address - Fax:703-385-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10201747OtherCIGNA
VA281834OtherAMERIGROUP
VA3298983OtherHEALTH MARKET
VA0497394OtherUNITED HEALTHCARE
VA90229OtherAETNA
VA16440001OtherCAREFIRST
VA200886OtherBLUE CROSS BLUE SHIELDS
VA6065091Medicaid
VA834168OtherALLIANCE AND MAMSI
VA10201747OtherCIGNA
VA834168OtherALLIANCE AND MAMSI