Individual ProviderNicholas PhamStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1 Kneeland St, Boston, MA 02111-1527(617) 636-6828(818) 450-4598PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Pham does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1033953104Provider TypeIndividualFull NamePham, NicholasGenderMaleSole ProprietorNoEnumeration Date6/24/2024Last Updated6/24/2024Contact InformationPractice LocationPractice Address1 Kneeland St, Boston, MA 02111-1527Phone(617) 636-6828FaxUnlisted FaxMailing LocationMailing Address106 Tyler St, Boston, MA 02111-1831Phone(818) 450-4598FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer