Provider Demographics
NPI:1801864517
Name:TRAN, LOC VAN (MD)
Entity Type:Individual
Prefix:
First Name:LOC
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6340
Mailing Address - Fax:610-534-6342
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6340
Practice Address - Fax:610-534-6342
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD053136L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014736580004Medicaid
PAG17325Medicare UPIN
PATR191006Medicare ID - Type Unspecified