Provider Demographics
NPI:1447232731
Name:TRAMO, MARK JUDE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JUDE
Last Name:TRAMO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 LYNN RD STE 303
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8003
Mailing Address - Country:US
Mailing Address - Phone:805-495-6702
Mailing Address - Fax:805-495-6195
Practice Address - Street 1:2220 LYNN RD STE 303
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8003
Practice Address - Country:US
Practice Address - Phone:805-495-6702
Practice Address - Fax:805-495-6195
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG885912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075926OtherTUFTS HEALTH PLAN
CA1447232731Medicaid
MA3070867Medicaid
MAJ12897OtherBCBS MA
CA1447232731Medicaid
MA075926OtherTUFTS HEALTH PLAN
CADH620YMedicare PIN