Provider Demographics
NPI:1144258120
Name:NGUYEN, QUAN CHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:QUAN
Middle Name:CHUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 PRIDES XING STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6109
Mailing Address - Country:US
Mailing Address - Phone:302-998-0300
Mailing Address - Fax:302-543-8456
Practice Address - Street 1:700 PRIDES XING STE 200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6109
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:302-543-8456
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002745207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE030004391OtherRAILROAD MEDICARE
DE0108315000OtherHIGHMARK BCBS
DE480074OtherAMERIHEATH
DE1730OtherCOVENTRY
DE4259775OtherAETNA
DE1145968BOtherCIGNA
DE0000040501Medicaid
DE4259775OtherAETNA