Provider Demographics
NPI:1205058781
Name:NGOC AN PHAN, PC
Entity type:Organization
Organization Name:NGOC AN PHAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:AN
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-923-6080
Mailing Address - Street 1:909 S. 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3701
Mailing Address - Country:US
Mailing Address - Phone:215-923-6080
Mailing Address - Fax:215-923-2082
Practice Address - Street 1:909 S. 11TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3701
Practice Address - Country:US
Practice Address - Phone:215-923-6080
Practice Address - Fax:215-923-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039037L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA09000171Medicaid
PA428533Medicare ID - Type Unspecified
PA09000171Medicaid