Provider Demographics
NPI:1417903352
Name:PHAM, NHUNG S (MD)
Entity Type:Individual
Prefix:
First Name:NHUNG
Middle Name:S
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1953
Mailing Address - Country:US
Mailing Address - Phone:614-268-6555
Mailing Address - Fax:614-457-5723
Practice Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1953
Practice Address - Country:US
Practice Address - Phone:614-268-6555
Practice Address - Fax:614-457-5723
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.071379207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2164161Medicaid
PH4224291Medicare PIN
OH2164161Medicaid