Basic Information
| Provider Information | |||||||||
| NPI: | 1982702635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | THANH-HA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 N 28TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232235311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046441665 | ||||||||
| FaxNumber: | 8046445285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 N 28TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232235311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046441665 | ||||||||
| FaxNumber: | 8046445285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 22163 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101244710 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001788654 | 01 | WV | BLUE CROSS BLUE SHIELD | OTHER | 3810004094 | 05 | WV | MEDICAID | C06695 | 01 | VA | GROUP PTAN | OTHER |