Provider Demographics
NPI:1851355598
Name:NGUYEN, BAO-DAN TRAN (DO)
Entity Type:Individual
Prefix:
First Name:BAO-DAN
Middle Name:TRAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2500
Mailing Address - Country:US
Mailing Address - Phone:610-269-7656
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:101 MANOR AVENUE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2601
Practice Address - Country:US
Practice Address - Phone:610-269-7656
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102221827Medicaid
I27373Medicare UPIN