Provider Demographics
NPI:1073518684
Name:TRAN, DUC THI (MD)
Entity Type:Individual
Prefix:
First Name:DUC
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88 W
Mailing Address - Street 2:STE 102
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-836-9300
Mailing Address - Fax:732-836-9305
Practice Address - Street 1:1608 ROUTE 88 W
Practice Address - Street 2:STE 102
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-836-9300
Practice Address - Fax:732-836-9305
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ300116857OtherRAIL ROAD MEDICARE
NJ500500Medicare ID - Type Unspecified
NJ300116857OtherRAIL ROAD MEDICARE