Basic Information
| Provider Information | |||||||||
| NPI: | 1184737918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | MY-LAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST STATE STREET | ||||||||
| Address2: | PO BOX 1250 | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187735729 | ||||||||
| FaxNumber: | 5187754118 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 EAST STATE STREET | ||||||||
| Address2: | MAB-GPCC | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187735729 | ||||||||
| FaxNumber: | 5187754118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 210073 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000490195001 | 01 | NY | BSH NE NY | OTHER | 15456 | 01 | NY | MVP HEALTH PLAN | OTHER | 02007894 | 05 | NY | MEDICAID | 10027129 | 01 | NY | CDPHP | OTHER |