Provider Demographics
NPI:1679796635
Name:VIETJE, UYEN PHUONG (MD)
Entity type:Individual
Prefix:DR
First Name:UYEN PHUONG
Middle Name:
Last Name:VIETJE
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 1:107 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05682-9791
Mailing Address - Country:US
Mailing Address - Phone:802-578-7702
Mailing Address - Fax:
Practice Address - Street 1:77 NEALY AVE
Practice Address - Street 2:LANGLEY AFB PATHOLOGY DEPT
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2040
Practice Address - Country:US
Practice Address - Phone:757-764-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT390200000X
PAMD438637207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program