Provider Demographics
NPI:1770760340
Name:PHAM, THU THIEN (MD)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:THIEN
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 1:8140 ASHTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5699
Mailing Address - Country:US
Mailing Address - Phone:703-361-3128
Mailing Address - Fax:703-361-3670
Practice Address - Street 1:8140 ASHTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5699
Practice Address - Country:US
Practice Address - Phone:703-361-3128
Practice Address - Fax:033-613-6707
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437365207W00000X
OH57-012348207W00000X
VA0101269499207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102331328Medicaid
PA102331328Medicaid