Provider Demographics
NPI:1093754137
Name:PHAM, CHINH NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINH
Middle Name:NGOC
Last Name:PHAM
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 1:225 GRANDVIEW AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1729
Mailing Address - Country:US
Mailing Address - Phone:717-988-8200
Mailing Address - Fax:717-221-5644
Practice Address - Street 1:225 GRANDVIEW AVE STE 303
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1729
Practice Address - Country:US
Practice Address - Phone:717-988-8200
Practice Address - Fax:717-221-5644
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428289207P00000X, 2086S0120X, 2086S0129X, 208C00000X, 208G00000X, 208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101617699Medicaid
PA101617699Medicaid
PA101628Medicare PIN
PAP00663238Medicare PIN