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Organization

TRICARE MEDICAL GROUP, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRI PHAM MD (PRESIDENT)
(703) 578-0707
Entity
Organization

Contact information

Practice address
5985 COLUMBIA PIKE, SUITE 102, FALLS CHURCH, VA 22041-2043
(703) 578-0707
(703) 578-0909
Mailing address
5985 COLUMBIA PIKE, SUITE 102, FALLS CHURCH, VA 22041
(703) 578-0707
(703) 578-0909

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101235759
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010199620
VA
Enumeration date
09/06/2007
Last updated
11/10/2011
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