Provider Demographics
NPI:1427067537
Name:PHAM, PHUONG-ANH THI (MD)
Entity type:Individual
Prefix:
First Name:PHUONG-ANH
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-7006
Mailing Address - Fax:910-907-7112
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-5219
Practice Address - Country:US
Practice Address - Phone:910-907-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62741207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00810748088OtherPHCS
CA2238002OtherFIRST HEALTH
CAMCMG443200OtherWESTERN HEALTH ADVANTAGE
CA00A27410Medicaid
CA1974992OtherGREAT WEST
CA5064086OtherCIGNA
CA90201153OtherPACIFICARE
CA128827OtherHEALTH NET
CA7581749OtherAETNA
CAA62741OtherBLUE CROSS
CA257714OtherINTERPLAN
CA2618299OtherUNITED HEALTHCARE
CA5668612OtherFIRST HEALTH
CAA62741OtherBLUE CROSS
CA00A627411Medicare ID - Type Unspecified