Provider Demographics
NPI:1104854983
Name:PHAM, LAN PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:LAN PHUONG
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAN
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3774
Mailing Address - Country:US
Mailing Address - Phone:914-484-1518
Mailing Address - Fax:845-251-4136
Practice Address - Street 1:1825 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4432
Practice Address - Country:US
Practice Address - Phone:914-772-9983
Practice Address - Fax:845-251-4136
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207363207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02235023Medicaid
NYA400104767OtherMEDICARE PTAN
H15092Medicare UPIN