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General NPI Number Information
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NPI Number | 1912437773
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Entity Type | Individual
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Provider Name | DIANA Q PHAM MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1215 LEE ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0804
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Country | US
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Telephone | 434-924-3627
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Fax | 434-443-4260
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Provider Business Mailing Address
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Address Line | PO BOX 749112
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City | ATLANTA
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State | GA
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Zip | 30374-9112
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Country | US
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Telephone | 434-295-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 0101282767
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101282767
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License Number State | VA
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