Provider Demographics
NPI:1265633341
Name:PHAM, PHILLIP (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 W VOICE OF AMERICA PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3371
Mailing Address - Country:US
Mailing Address - Phone:513-860-0371
Mailing Address - Fax:513-860-1710
Practice Address - Street 1:7760 W VOICE OF AMERICA PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3371
Practice Address - Country:US
Practice Address - Phone:513-860-0371
Practice Address - Fax:513-860-1710
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340095992081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2986845Medicaid
IN200962470Medicaid
KY7100085070Medicaid
OH4274582Medicare PIN
OH2986845Medicaid