MEDICARE: DR. THANH-HA 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	207R00000X	Internal Medicine Physician	22163	WV
2	207R00000X	Internal Medicine Physician	0101244710	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001788654	OTHER	WV	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C06695	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1982702635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANH-HA PHAM MD

Provider Business Mailing Address
First Line	:	1510 N 28TH ST
Second Line	:	SUITE 308
City	:	RICHMOND
State	:	VA
Zip	:	23223-5311
Country	:	US
Telephone Number	:	804-644-1665
Fax Number	:	804-644-5285

Provider Business Practice Location Address
First Line	:	1510 N 28TH ST
Second Line	:	SUITE 308
City	:	RICHMOND
State	:	VA
Zip	:	23223-5311
Country	:	US
Telephone Number	:	804-644-1665
Fax Number	:	804-644-5285

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/29/2009

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Directions to “ DR. THANH-HA PHAM MD” Practice Location

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