Provider Demographics
NPI:1174121461
Name:PHAM, THUY LAM (PA-C)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:LAM
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 1:3626 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4412
Mailing Address - Country:US
Mailing Address - Phone:419-517-0146
Mailing Address - Fax:
Practice Address - Street 1:3626 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4412
Practice Address - Country:US
Practice Address - Phone:419-517-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant