Provider Demographics
NPI:1518313659
Name:PHAM, DAN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 SLEEPY HOLLOW RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2003
Mailing Address - Country:US
Mailing Address - Phone:703-241-8811
Mailing Address - Fax:703-241-8813
Practice Address - Street 1:2946 SLEEPY HOLLOW RD STE 3A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-241-8811
Practice Address - Fax:703-241-8813
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA155606207R00000X, 208M00000X
VA0101276629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518313659Medicaid