Provider Demographics
NPI:1386685378
Name:PHAN, HIEP C (MD)
Entity Type:Individual
Prefix:
First Name:HIEP
Middle Name:C
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 SOUTH SECOND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2119 MARIETTA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2207
Practice Address - Country:US
Practice Address - Phone:717-735-9222
Practice Address - Fax:717-735-3755
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-02-06
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Provider Licenses
StateLicense IDTaxonomies
PAMD418957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100815879Medicaid
PA100815879Medicaid
PAH93515Medicare UPIN