MEDICARE: JEANNIE PHAM MD

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	2084P0800X	Psychiatry Physician	D67481	MD
2	2084P0804X	Child & Adolescent Psychiatry Physician	D67481	MD

General Provider Information

NPI Number	:	1720271430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE PHAM MD

Provider Business Mailing Address
First Line	:	604 SOLAREX CT UNIT 201
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-8655
Country	:	US
Telephone Number	:	301-663-8263
Fax Number	:	301-682-5326

Provider Business Practice Location Address
First Line	:	604 SOLAREX CT UNIT 201
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-8655
Country	:	US
Telephone Number	:	301-663-8263
Fax Number	:	301-682-5326

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	06/18/2020

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