Provider Demographics
NPI:1023080942
Name:PHAM, TUAN HOAI (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:HOAI
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1718 E 4TH ST STE 807
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3280
Practice Address - Country:US
Practice Address - Phone:980-488-9630
Practice Address - Fax:980-488-9635
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107945208600000X, 2086S0120X
IN01088151A208600000X, 2086S0120X
ALMD.445722086S0120X
AZ414182086S0120X
NC2025-003892086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069171Medicaid
FL0031991-00Medicaid
H90006Medicare UPIN
MN999674500Medicaid
FL0031991-00Medicaid
FLGE088ZMedicare PIN
MN020001935Medicare ID - Type Unspecified