Provider Demographics
NPI:1528180890
Name:CHAT VAN PHAM, MD PA
Entity Type:Organization
Organization Name:CHAT VAN PHAM, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-438-8053
Mailing Address - Street 1:PO BOX 170743
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-0743
Mailing Address - Country:US
Mailing Address - Phone:469-438-8053
Mailing Address - Fax:972-690-7857
Practice Address - Street 1:1327 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5868
Practice Address - Country:US
Practice Address - Phone:469-438-8053
Practice Address - Fax:972-690-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W287Medicare ID - Type Unspecified
TX00W289Medicare ID - Type Unspecified
TX00W288Medicare ID - Type Unspecified