MEDICARE: MINH TAM PHAM PA-C

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1164227245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH TAM PHAM PA-C

Provider Business Mailing Address
First Line	:	12211 DORSETT RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 QUEENS PLZ S
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4101
Country	:	US
Telephone Number	:	646-647-1261
Fax Number	:

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

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	04/03/2025

Similar Medicare Providers

1184207656 — FERRUKH SHAMIM GHAURI DO
Practice Location Address:

2518 QUEENS PLZ S
LONG ISLAND CITY, NY
11101-4101

Practice Phone: 646-647-1261
Practice Fax:

1972572634 — DR. KENNETH HORUP D.C.
Practice Location Address:

4101 MAIN ST , SUITE A
HILTON HEAD ISLAND, SC
29926-4608

Practice Phone: 843-689-2273
Practice Fax: 843-342-3608

1598848889 — DR. MATTHEW RYAN MASTROROCCO D.M.D.
Practice Location Address:

4101 MAIN ST STE D
HILTON HEAD ISLAND, SC
29926-4609

Practice Phone: 843-682-4601
Practice Fax: 843-682-4602

1942370465 — DISCOVER SPECIFIC CHIROPRACTIC INC
Practice Location Address:

4101 MAIN STREET , SUITE A
HILTON HEAD ISLAND, SC
29926

Practice Phone: 843-689-2273
Practice Fax: 843-342-3608

1396879813 — LAURA S ROSENBAUM-BLOOM M.D.
Practice Location Address:

4101 MAIN STREET , SUITE C
HILTON HEAD ISLAND, SC
29926

Practice Phone: 843-342-6000
Practice Fax: 843-342-6001

1063631497 — DR. BRUCE ROB JOHNSON D.C.
Practice Location Address:

4101 MAIN ST , SUITE A
HILTON HEAD ISLAND, SC
29926-4608

Practice Phone: 843-342-3606
Practice Fax: 843-342-3608

Directions to “ MINH TAM PHAM PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.