MEDICARE: DR. KIEMANH 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	207P00000X	Emergency Medicine Physician	D69427	MD
2	207P00000X	Emergency Medicine Physician	A99032	CA

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	D69427	OTHER	MD	MD LICENSE

General Provider Information

NPI Number	:	1194971374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIEMANH PHAM M.D.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 SMITH AVE
Second Line	:	SUITE 3220
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3652
Country	:	US
Telephone Number	:	410-735-6403
Fax Number	:	410-735-6425

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

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	12/08/2021

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