Provider Demographics
NPI:1306015219
Name:CHAT VAN PHAM MD PA
Entity Type:Organization
Organization Name:CHAT VAN PHAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAT
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-265-2006
Mailing Address - Street 1:PO BOX 170743
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-0743
Mailing Address - Country:US
Mailing Address - Phone:817-265-2006
Mailing Address - Fax:972-690-7857
Practice Address - Street 1:1327 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5868
Practice Address - Country:US
Practice Address - Phone:817-265-2006
Practice Address - Fax:972-690-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W289Medicare PIN