Healthcare Provider Details

I. General information

NPI: 1083609309
Provider Name (Legal Business Name): TINA TONGA PHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN 408
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

6355 WALKER LN 408
ALEXANDRIA VA
22310-3245
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-5901
  • Fax: 703-719-9629
Mailing address:
  • Phone: 703-719-5901
  • Fax: 703-719-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101230372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: