Provider Demographics
NPI:1083606081
Name:PHAM, TRANG M (MD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:M
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:24A MAGOTHY BEACH RD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:410-255-2700
Practice Address - Fax:410-437-1962
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD434130900Medicaid
MD5800565OtherCIGNA PIN
MD2110690OtherMAMSI SPECIALIST
MD7412379OtherAETNA FEE FOR SERVICE
MDP15551OtherCAREFIRST MPOS
MD01-03279OtherUHC PROVIDER NUMBER
MD120197OtherJHHC PROVIDER NUMBER
MD2926883OtherAETNA CAPITATED
MD616172-01OtherCAREFIRST MD RENDERING
MD7605-0055OtherCAREFIRST BLUECHOICE
MD8110690OtherMAMSI PRIMARY CARE
MD080188672OtherRR MEDICARE
MDD0058368OtherMHIP PROVIDER ID
MDE216Medicare PIN
MD434130900Medicaid