Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD428289 | PA |
Y | 208200000X | Surgeon | MD428289 | PA |
Y | 208600000X | Surgeon | MD428289 | PA |
N | 2086S0120X | Pediatric Surgery | MD428289 | PA |
N | 2086S0129X | Vascular Surgeon | MD428289 | PA |
N | 208C00000X | Colorectal Surgeon | MD428289 | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD428289 | PA |
NPI | 1093754137 |
---|---|
Provider Name | Dr. Chinh Ngoc Pham |
First Address | Mechanicsburg, PA 17050-9402 |
Second Address | Mechanicsburg, PA 17050-9402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101617699 | (05) | PA |
I53873 | (02) | PA |