MEDICARE: DR. NGHIA T. PHAN 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	MD021857-E	PA
2	207R00000X	Internal Medicine Physician	MD021857-E	PA

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

General Provider Information

NPI Number	:	1215994835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGHIA T. PHAN M.D.

Provider Business Mailing Address
First Line	:	1534 S 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-6538
Country	:	US
Telephone Number	:	215-468-5198
Fax Number	:	215-468-5198

Provider Business Practice Location Address
First Line	:	6800 MARKET ST
Second Line	:	SUITE # 2H
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2412
Country	:	US
Telephone Number	:	215-468-5198
Fax Number	:	610-734-7511

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/21/2022

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