Provider Demographics
NPI:1851507131
Name:PHAM, CHRISTINE K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7721
Mailing Address - Country:US
Mailing Address - Phone:931-787-1362
Mailing Address - Fax:931-210-5362
Practice Address - Street 1:2995 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7721
Practice Address - Country:US
Practice Address - Phone:931-787-1362
Practice Address - Fax:931-210-5362
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184578207V00000X
TN46344207V00000X
PAMD435334207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN46344OtherMEDICAL LICENSURE
137232EDSMedicare PIN