Individual provider Active NPI

Tony V Pham, MD, MSCGH

  • Psychiatry Physician
  • Boston, MA
National Provider Identifier
1336536556
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
288546 Issued in MA
Practice address
1 Bowdoin SQ FL 6
Boston, MA 02114-2927
Phone
(617) 726-8895
NPI assigned
Apr 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 288546 MA Primary

Addresses

Primary practice location

1 Bowdoin SQ FL 6
Boston, MA 02114-2927

Mailing address

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210929002587 MA Practitioner - Psychiatry 2860899150 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
288546MAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mass General Brigham Medical Group Northern Massachusetts Inc CurrentSince Jul 1, 2021 Accepting new patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc Psychiatry CurrentSince Jul 1, 2021 Accepting new patients
The General Hospital Corporation CurrentSince Jul 1, 2021 Accepting new patients

Locations

1 Bowdoin Sq
Fl 6
Boston, MA 02114
Phone (617) 643-0877

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

1 Hutchinson Dr
Danvers, MA 01923
Phone (978) 739-6950

Interoperability endpoints

  • Direct secure messaging: pham.tony.mgh@direct.partners.masshiway.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1336536556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOWDOIN SQ FL 6",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142927",
            "telephone_number": "617-726-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "TONY",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "MD, MSCGH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-26",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "288546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.