Provider Demographics
NPI:1578096491
Name:PHAM, THU-MINH DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:THU-MINH
Middle Name:DIANE
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40 LA RIVIERE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4344
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-893-1001
Practice Address - Street 1:40 LA RIVIERE DR STE 140
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4306
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-893-1001
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY306271207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine