Healthcare Provider Details

I. General information

NPI: 1831146125
Provider Name (Legal Business Name): DANG TUAN PHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 HARLEM RD SUITE 160
BUFFALO NY
14225-4031
US

IV. Provider business mailing address

2625 HARLEM RD SUITE 160
BUFFALO NY
14225-4031
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-0333
  • Fax: 716-893-3038
Mailing address:
  • Phone: 716-893-0333
  • Fax: 716-893-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39502
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number251073-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301080957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: