MEDICARE: CHAT VAN PHAM, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1528180890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAT VAN PHAM, MD PA

Provider Business Mailing Address
First Line	:	PO BOX 170743
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76003-0743
Country	:	US
Telephone Number	:	469-438-8053
Fax Number	:	972-690-7857

Provider Business Practice Location Address
First Line	:	1327 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5868
Country	:	US
Telephone Number	:	469-438-8053
Fax Number	:	972-690-7857

Authorized Official
Title or Position	:	BILLING
Name	:	LIEU TRAN
Credential	:
Telephone Number	:	469-438-8053

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	02/23/2011

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