Provider Demographics
NPI:1831146125
Name:PHAM, DANG TUAN (MD)
Entity Type:Individual
Prefix:
First Name:DANG TUAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-893-0333
Mailing Address - Fax:716-893-3038
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 160
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-893-0333
Practice Address - Fax:716-893-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY39502208600000X
NY251073-1208600000X
MI4301080957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery