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General NPI Number Information
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NPI Number | 1790100261
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PLLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 4102 E PARHAM RD
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City | HENRICO
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State | VA
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Zip | 23228-2743
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Country | US
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Telephone | 804-912-2359
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Fax |
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Provider Business Mailing Address
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Address Line | 4102 E PARHAM RD
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City | HENRICO
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State | VA
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Zip | 23228-2743
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Country | US
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Telephone | 804-912-2359
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | THANH-HA PHAM
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Credential |
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Telephone | 804-912-2359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101244710
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License Number State | VA
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