Provider Demographics
NPI:1215994835
Name:PHAN, NGHIA T (MD)
Entity type:Individual
Prefix:DR
First Name:NGHIA
Middle Name:T
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1534 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6538
Mailing Address - Country:US
Mailing Address - Phone:215-468-5198
Mailing Address - Fax:215-468-5198
Practice Address - Street 1:6800 MARKET ST
Practice Address - Street 2:SUITE # 2H
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2412
Practice Address - Country:US
Practice Address - Phone:215-468-5198
Practice Address - Fax:610-734-7511
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021857-E207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00798990Medicaid
PA00798990Medicaid
PA000025235Medicare ID - Type UnspecifiedHIGHMARK ID