Provider Demographics
NPI:1538652722
Name:LAM, QUYNHDIEM THI
Entity Type:Individual
Prefix:
First Name:QUYNHDIEM
Middle Name:THI
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 68TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1637
Mailing Address - Country:US
Mailing Address - Phone:267-694-7150
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD YORK ROAD
Practice Address - Street 2:PRICE BUILDING, SUITE 604
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:215-481-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215470208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery