Healthcare Provider Details

I. General information

NPI: 1629728894
Provider Name (Legal Business Name): TUYET NGAN THI PHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

701 N CLAYTON ST
WILMINGTON DE
19805-3155
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2200
  • Fax: 814-371-2200
Mailing address:
  • Phone: 302-575-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD488224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: