Healthcare Provider Details

I. General information

NPI: 1366015448
Provider Name (Legal Business Name): THAO KIM PHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33270 US HIGHWAY 264
ENGELHARD NC
27824-9557
US

IV. Provider business mailing address

PO BOX 277
ENGELHARD NC
27824-0277
US

V. Phone/Fax

Practice location:
  • Phone: 252-925-7000
  • Fax: 252-925-7700
Mailing address:
  • Phone: 252-925-7000
  • Fax: 252-925-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-11951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: