Provider Demographics
NPI:1871531087
Name:NGUYEN, BAO DINH (MD)
Entity type:Individual
Prefix:DR
First Name:BAO
Middle Name:DINH
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 1:2706 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-2427
Mailing Address - Country:US
Mailing Address - Phone:856-964-2801
Mailing Address - Fax:856-964-2080
Practice Address - Street 1:2706 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2427
Practice Address - Country:US
Practice Address - Phone:856-964-2801
Practice Address - Fax:856-964-2080
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3949206-01Medicaid
NJE37334Medicare UPIN
NJ3949206-01Medicaid