Provider Demographics
NPI:1083609309
Name:PHAM, TINA TONGA (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:TONGA
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:408
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-719-5901
Mailing Address - Fax:703-719-9629
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:408
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-719-5901
Practice Address - Fax:703-719-9629
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2021-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6210481Medicaid
VA6210481Medicaid
N46535Medicare UPIN