Provider Demographics
NPI:1184932899
Name:PHAM, LINH (MD)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:
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 1:10000 W COLONIAL DR STE 381
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3435
Mailing Address - Country:US
Mailing Address - Phone:321-841-3467
Mailing Address - Fax:407-253-2563
Practice Address - Street 1:10000 W COLONIAL DR STE 381
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3435
Practice Address - Country:US
Practice Address - Phone:321-841-3467
Practice Address - Fax:407-253-2563
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-41176208M00000X
FLME159350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116406600Medicaid