Provider Demographics
NPI:1972553394
Name:BAO, TRUONG (MD)
Entity Type:Individual
Prefix:
First Name:TRUONG
Middle Name:
Last Name:BAO
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 1:10110 MOLECULAR DR STE 114
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7538
Mailing Address - Country:US
Mailing Address - Phone:301-780-4745
Mailing Address - Fax:301-605-7550
Practice Address - Street 1:10110 MOLECULAR DR STE 114
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7538
Practice Address - Country:US
Practice Address - Phone:301-780-4745
Practice Address - Fax:301-605-7550
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699026600Medicaid
DC00A762M50Medicare ID - Type Unspecified
MD699026600Medicaid