Provider Demographics
NPI:1376543157
Name:TRAN, TRONG D (MD)
Entity Type:Individual
Prefix:DR
First Name:TRONG
Middle Name:D
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S LENOLA RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1561
Mailing Address - Country:US
Mailing Address - Phone:856-234-0258
Mailing Address - Fax:856-727-9518
Practice Address - Street 1:509 S LENOLA RD STE 11A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-234-0258
Practice Address - Fax:856-727-9518
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433922207W00000X
NJ25MA07962500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088358Medicaid
NJP00301431Medicare PIN
I02392Medicare UPIN
NJ097249BK7Medicare PIN