Provider Demographics
NPI:1174516892
Name:NGUYEN, THOMAS BAO (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NW WASHINGTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6386
Mailing Address - Country:US
Mailing Address - Phone:513-867-9000
Mailing Address - Fax:513-785-3675
Practice Address - Street 1:903 NW WASHINGTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6386
Practice Address - Country:US
Practice Address - Phone:513-867-9000
Practice Address - Fax:513-785-3675
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2016-07-01
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
OH72672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2022788Medicaid
OH2022788Medicaid
OH0838091Medicare PIN
OHH369932Medicare PIN