Pham, Dominique
Pham, Dominique is an sole proprietor health care provider with primary practice located at 1996 Centre St , West Roxbury MA 02132-3329. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Gastroenterology. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Pham, Dominique can be contacted via phone (617) 469-0470.Contact Information
Primary practice address
1996 Centre St
West Roxbury MA 02132-3329
Phone: (617) 469-0470
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 74589 | Massachusetts |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 74589 | Massachusetts |
Profile Details
| NPI number | 1891776662 |
|---|---|
| LBN Legal business name | Pham, Dominique |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 9th, 2005 |
| Last updated | Jan 14th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891776662 | NPPES |
| Massachusetts | MEDICAID | 3129063 |
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