Provider Demographics
NPI:1528619640
Name:PHAM, CINDY (PA-C)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 LEWINSVILLE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2834
Mailing Address - Country:US
Mailing Address - Phone:703-287-8277
Mailing Address - Fax:
Practice Address - Street 1:7601 LEWINSVILLE RD STE 400
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2834
Practice Address - Country:US
Practice Address - Phone:703-287-8277
Practice Address - Fax:703-287-8278
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110011240363AS0400X
TXPA15800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical