CONNIE PHAM, M.D.,P.A. NPI 1659558195

Family Medicine (Adolescent Medicine) in Georgetown, TX

About CONNIE PHAM, M.D.,P.A.

Connie Pham, M.d.,p.a. is a provider in Georgetown, TX. The NPI number assigned to this provider is 1659558195. The practitioner's primary taxonomy code is Family Medicine (207QA0000X). The provider is registered as an organization and their NPI record was last updated 11 years ago. Connie Pham, M.d.,p.a. operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI

1659558195

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameCONNIE PHAM, M.D.,P.A.
Provider Location Address2118 SCENIC DR GEORGETOWN, TX 78626 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address2118 SCENIC DR GEORGETOWN, TX 78626 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date01-28-2008 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date01-28-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Primary Taxonomy

Taxonomy Code207QA0000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationAdolescent Medicine
License No.H8321
License StateTX
Taxonomy DescriptionA family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.

Business Address

CONNIE PHAM, M.D.,P.A.
2118 SCENIC DR
GEORGETOWN, TX
ZIP 78626
Phone: (512) 863-5678

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Mailing Address

CONNIE PHAM, M.D.,P.A.
2118 SCENIC DR
GEORGETOWN, TX
ZIP 78626
Phone: (512) 863-5678

Authorized Official

Authorized Official NameDR. CONNIE L. PHAM M.D. Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleDOCTOR/OWNER
Authorized Official Phone

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
F25237MEDICARE UPIN (02)TX

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1053533026DR. MARY A EVERS DO
Individual
Dermatology2118 SCENIC DR
GEORGETOWN, TX 78626
(512) 868-9800
1154633303TEXAS DERMATOLOGY CENTER PLLC
Organization
Dermatology2118 SCENIC DR
GEORGETOWN, TX 78626
(512) 868-9800
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