Provider Demographics
NPI:1871348946
Name:PHAM, ANNABELLE HONG-AN (MSPAS)
Entity type:Individual
Prefix:MS
First Name:ANNABELLE
Middle Name:HONG-AN
Last Name:PHAM
Suffix:
Gender:F
Credentials:MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8178 PAPER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5652
Mailing Address - Country:US
Mailing Address - Phone:703-628-4268
Mailing Address - Fax:
Practice Address - Street 1:125 WOODSTREAM BLVD STE 205
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4630
Practice Address - Country:US
Practice Address - Phone:540-371-0079
Practice Address - Fax:540-656-2653
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010089363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant