Individual provider · NPI-1

Tin Ha Ngoc, MD

Family Medicine · Gorham, ME

NPI number1073877791
StatusActive
Last updated in NPPESSep 23, 2020

Details

NPI
1073877791
Entity type
Individual (NPI-1)
Name
Tin Ha Ngoc
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 27, 2012
Certification date
Sep 23, 2020
Last updated
Sep 23, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineMD20742MEYes

Practice location

575 Main St
Gorham, ME 04038-2623

Phone 207-839-2559 · Fax 207-523-1135

Mailing address

Po Box 9746
Portland, ME 04104-5040

Phone 207-791-3888 · Fax 207-828-7850

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