Provider Demographics
NPI:1265683379
Name:TRAN, TRANG M (MD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:M
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 1:3515 AGUA SARCA CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5266
Mailing Address - Country:US
Mailing Address - Phone:816-550-8693
Mailing Address - Fax:
Practice Address - Street 1:3515 AGUA SARCA CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5266
Practice Address - Country:US
Practice Address - Phone:816-550-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2008-0787OtherNEW MEXICO LICENSE
CT047056OtherCONNECTICUT LICENSE NUMBER