Provider Demographics
NPI:1376650580
Name:TRUONG, NICHOLAS HOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HOANG
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NGHIEP
Other - Middle Name:HOANG
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:133 E LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1011
Mailing Address - Country:US
Mailing Address - Phone:215-426-9344
Mailing Address - Fax:215-426-3028
Practice Address - Street 1:133 E LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1011
Practice Address - Country:US
Practice Address - Phone:215-426-9344
Practice Address - Fax:215-426-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033076E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0991200Medicaid
PAB29803Medicare UPIN
PA001084Medicare ID - Type Unspecified