Healthcare Provider Details

I. General information

NPI: 1215994835
Provider Name (Legal Business Name): NGHIA T. PHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MARKET ST SUITE # 2H
UPPER DARBY PA
19082-2412
US

IV. Provider business mailing address

1534 S 5TH ST
PHILADELPHIA PA
19147-6538
US

V. Phone/Fax

Practice location:
  • Phone: 215-468-5198
  • Fax: 610-734-7511
Mailing address:
  • Phone: 215-468-5198
  • Fax: 215-468-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD021857-E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD021857-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: