MEDICARE: DR. TRANG M PHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0058368	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	080188672	OTHER	MD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5800565	OTHER	MD	CIGNA PIN
3	2110690	OTHER	MD	MAMSI SPECIALIST
4	7412379	OTHER	MD	AETNA FEE FOR SERVICE
5	P15551	OTHER	MD	CAREFIRST MPOS
6	01-03279	OTHER	MD	UHC PROVIDER NUMBER
7	120197	OTHER	MD	JHHC PROVIDER NUMBER
8	2926883	OTHER	MD	AETNA CAPITATED
9	616172-01	OTHER	MD	CAREFIRST MD RENDERING
10	7605-0055	OTHER	MD	CAREFIRST BLUECHOICE
11	8110690	OTHER	MD	MAMSI PRIMARY CARE
13	D0058368	OTHER	MD	MHIP PROVIDER ID

General Provider Information

NPI Number	:	1083606081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRANG M PHAM M.D.

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	24A MAGOTHY BEACH RD.
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-6837
Country	:	US
Telephone Number	:	410-255-2700
Fax Number	:	410-437-1962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	05/24/2012

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Directions to “ DR. TRANG M PHAM M.D.” Practice Location

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