=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902122922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAO DUY PHAM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2010
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6719 GOVERNOR GC PEERY HWY STE 2600
-----------------------------------------------------
City | RICHLANDS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-596-6544
-----------------------------------------------------
Fax | 276-596-6548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6719 GOVERNOR GC PEERY HWY STE 2600
-----------------------------------------------------
City | RICHLANDS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24641-0279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-596-6544
-----------------------------------------------------
Fax | 276-596-6548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 0101263930
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------