Healthcare Provider Details

I. General information

NPI: 1528619640
Provider Name (Legal Business Name): CINDY PHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 LEWINSVILLE RD STE 400
MC LEAN VA
22102-2834
US

IV. Provider business mailing address

7601 LEWINSVILLE RD STE 400
MC LEAN VA
22102-2834
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-8277
  • Fax: 703-287-8278
Mailing address:
  • Phone: 703-287-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110011240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: