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NPI Code Detail

MEDICARE: HIEP PHAM

MEDICARE: HIEP PHAM
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician22778SC
2207QG0300XGeriatric Medicine (Family Medicine) Physician9601434NC

General Provider Information

NPI Number : 1780690503
Entity Type Code : Individual
Provider Name (Legal Business Name) : HIEP PHAM
Provider Business Mailing Address
First Line : 5730 EXECUTIVE DR STE 230
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1762
Country : US
Telephone Number : 410-402-2379
Fax Number : 410-469-3085
Provider Business Practice Location Address
First Line : 2030 WINDSOR RUN LN
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-0054
Country : US
Telephone Number : 704-443-6250
Fax Number : 704-443-6279
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 04/04/2022

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Directions to “ HIEP PHAM ” Practice Location

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