Provider Demographics
NPI:1982702635
Name:PHAM, THANH-HA (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH-HA
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 1:1510 N 28TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5311
Mailing Address - Country:US
Mailing Address - Phone:804-644-1665
Mailing Address - Fax:804-644-5285
Practice Address - Street 1:1510 N 28TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5311
Practice Address - Country:US
Practice Address - Phone:804-644-1665
Practice Address - Fax:804-644-5285
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22163207R00000X
VA0101244710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001788654OtherBLUE CROSS BLUE SHIELD
WV3810004094Medicaid
VAC06695OtherGROUP PTAN
WV4154661Medicare PIN
WVI42671Medicare UPIN
WV4154662Medicare PIN
WV001788654OtherBLUE CROSS BLUE SHIELD