Provider Demographics
NPI:1558501320
Name:TRAN, BAO CHAU MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:BAO CHAU
Middle Name:MINH
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 1:590 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3948
Mailing Address - Country:US
Mailing Address - Phone:732-718-3165
Mailing Address - Fax:
Practice Address - Street 1:285 DURHAM AVE
Practice Address - Street 2:SUITE 1A BLD 6
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2546
Practice Address - Country:US
Practice Address - Phone:732-338-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08559100207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03538896Medicaid
NJ0240613Medicaid
NJ020756Medicare PIN