Individual
DOMINIQUE PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1996 CENTRE ST, WEST ROXBURY, MA 02132-3329
(617) 469-0470
Mailing address
PO BOX 9135, ATT:SHARON SILVA, BROOKLINE, MA 02446-9135
(603) 890-4404
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
74589
MA
207RG0100X
Gastroenterology Physician
74589
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3129063
—
MA
Enumeration date
11/09/2005
Last updated
01/14/2010
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