Provider Demographics
NPI:1467548032
Name:TRAN-PHU, LAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:P
Last Name:TRAN-PHU
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 1:203 SEDBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4939
Mailing Address - Country:US
Mailing Address - Phone:910-483-4779
Mailing Address - Fax:
Practice Address - Street 1:227 FOUNTAINHEAD LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5417
Practice Address - Country:US
Practice Address - Phone:910-433-3652
Practice Address - Fax:910-433-3701
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01176208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1051UMedicaid
NC1051UMedicaid
NC2254699Medicare ID - Type Unspecified