Basic Information
| Provider Information | |||||||||
| NPI: | 1730703117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGO | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | VIET | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 WEST 24TH STREET | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16502 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 311 WEST 24TH STREET | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2020 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT220507 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.