Provider Demographics
NPI:1679538987
Name:NGUYEN, MAI CHI (MD)
Entity type:Individual
Prefix:
First Name:MAI CHI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2470
Mailing Address - Country:US
Mailing Address - Phone:410-531-0700
Mailing Address - Fax:410-531-8451
Practice Address - Street 1:7350 GRACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2470
Practice Address - Country:US
Practice Address - Phone:410-531-0700
Practice Address - Fax:410-531-8451
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036845207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD531421600Medicaid
MD934QMedicare ID - Type UnspecifiedMEDICAL DOCTOR
MDE14031Medicare UPIN