Provider Demographics
NPI:1003012907
Name:PHAN, TERESA THUANH (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:THUANH
Last Name:PHAN
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 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 S HIGH ST
Practice Address - Street 2:SUITE 25
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-6101
Practice Address - Country:US
Practice Address - Phone:614-533-6700
Practice Address - Fax:614-224-8562
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3082962Medicaid
OH4304401Medicare PIN