Provider Demographics
NPI:1497917082
Name:BICH-NGOC T. PHAM, MD, LLC
Entity Type:Organization
Organization Name:BICH-NGOC T. PHAM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BICH-NGOC
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-749-0844
Mailing Address - Street 1:11011 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2628
Mailing Address - Country:US
Mailing Address - Phone:813-749-0844
Mailing Address - Fax:813-749-0846
Practice Address - Street 1:11011 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2628
Practice Address - Country:US
Practice Address - Phone:813-749-0844
Practice Address - Fax:813-749-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101516207Q00000X
FLME101516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty