Provider Demographics
NPI:1326484221
Name:PHAM, QUANG H (MD)
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:H
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:7617 LITTLE RIVER TPKE STE 850
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2673
Practice Address - Country:US
Practice Address - Phone:571-665-6620
Practice Address - Fax:571-665-6621
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101279732207R00000X
SC84759207R00000X
NC2016-00077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine