Provider Demographics
NPI:1831327444
Name:NGO, THUY-TRANG THI (MD)
Entity type:Individual
Prefix:
First Name:THUY-TRANG
Middle Name:THI
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 LAKE OTIS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5235
Mailing Address - Country:US
Mailing Address - Phone:907-375-5200
Mailing Address - Fax:907-375-5203
Practice Address - Street 1:4015 LAKE OTIS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5235
Practice Address - Country:US
Practice Address - Phone:073-755-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12407207R00000X
TXP5694207R00000X
AK134386207R00000X
ORMD171966207R00000X
WA60444255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20004867Medicare PIN