Provider Demographics
NPI:1922113562
Name:TRUONG, ALICE X (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:X
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THANH XUAN
Other - Middle Name:T
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2502
Mailing Address - Country:US
Mailing Address - Phone:781-662-2243
Mailing Address - Fax:781-662-4878
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 322
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-662-2243
Practice Address - Fax:781-662-4878
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2198122084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09464Medicare UPIN
MAA36714Medicare ID - Type Unspecified