Provider Demographics
NPI:1285826198
Name:PHAM & LIU LLC
Entity Type:Organization
Organization Name:PHAM & LIU LLC
Other - Org Name:NANCY W LIU M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-4323
Mailing Address - Street 1:5678 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2206
Mailing Address - Country:US
Mailing Address - Phone:937-434-4323
Mailing Address - Fax:937-434-4541
Practice Address - Street 1:5678 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2206
Practice Address - Country:US
Practice Address - Phone:937-434-4323
Practice Address - Fax:937-434-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9327061Medicare PIN