Provider Demographics
NPI:1700814944
Name:PHAM, TRINH CONG (DO)
Entity type:Individual
Prefix:
First Name:TRINH
Middle Name:CONG
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:# 350
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1355
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1340
Practice Address - Fax:410-494-1240
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-12-07
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Provider Licenses
StateLicense IDTaxonomies
MDH59518207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF71637Medicare UPIN
MDF147Medicare PIN
MD157676Medicare PIN
157879ZR0ZMedicare PIN