Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D68124 | MD |
NPI | 1013991884 |
---|---|
Provider Name | Dr. Annette M Pham |
First Address | Rockville, MD 20852-4250 |
Second Address | Rockville, MD 20852-4250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 06/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020467600 | (05) | MD |
1013991884 | MEDICARE PTAN (01) | MD |