Trung Hoa Pham, MD, LLC
Organization Active NPI Internal Medicine Physician · Randallstown, MD
NPI 1366579161 · NPPES record last updated Apr 13, 2011
Key facts
- NPI
- 1366579161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- D0047704 (MD)
- Legal business name
- TRUNG HOA PHAM, MD, LLC
- Practice address
- 5415 Old Court Rd Ste 102
Randallstown, MD 21133-5103 - Phone
- (410) 701-4600
- Fax
- (410) 701-4481
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Trung Hoa Pham, M.D.
- Title
- President
- Phone
- (443) 604-8928
Practitioners 2
-
Trung H Pham, M.D.
-
Jeffrey M Kufel, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070711000863 | MD | Part B Supplier - Clinic/Group Practice | 8527168111 |
Receives reassigned benefits from 2 practitioners Practice locations: Baltmore, MD; Randallstown, MD |
National Provider Directory
Locations
1838 Greene Tree Rd
Ste 325
Pikesville, MD 21208
Phone (410) 486-0927
5401 Old Court Rd
Fl 4
Randallstown, MD 21133
Phone (410) 486-0111
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CAGBDA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | D0047704 | MD | Yes |
Addresses
Primary practice location
5415 Old Court Rd Ste 102
Randallstown, MD 21133-5103
Mailing address
6509 Early Lily Row
Columbia, MD 21044-6057
Phone (410) 701-4600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 484802100 | Medicaid | MD |
Other providers in Randallstown, MD
- Tracey R Trainum
- Rashad Trammell
- Audra Benee Travers
- Tripplemo Support Services, Inc
- Tristate Home Health Services Inc.
- Kelly Monique Turner Woolford
- Delores B Turner-Brock
- Amar Turner
- Brittany Turner
- Deverie Lee Turner
All providers in Randallstown, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.