Basic Information
| Provider Information | |||||||||
| NPI: | 1568673812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | PHONG | ||||||||
| MiddleName: | QUOC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2422 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126995774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1197 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N5802 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | OS014864 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.