Provider Demographics
NPI:1093007098
Name:TRAN, BRIAN PHAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PHAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7015
Mailing Address - Country:US
Mailing Address - Phone:607-727-5683
Mailing Address - Fax:
Practice Address - Street 1:2651 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-7015
Practice Address - Country:US
Practice Address - Phone:607-727-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277792-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics