MEDICARE: PRIMARY CARE PLLC

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	207R00000X	Internal Medicine Physician	0101244710	VA

General Provider Information

NPI Number	:	1790100261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	4102 E PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2743
Country	:	US
Telephone Number	:	804-912-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 E PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2743
Country	:	US
Telephone Number	:	804-912-2359
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	THANH-HA PHAM
Credential	:
Telephone Number	:	804-912-2359

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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