MEDICARE: DUC THI TRAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA59193	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300116857	OTHER	NJ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1073518684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUC THI TRAN M.D.

Provider Business Mailing Address
First Line	:	1608 ROUTE 88 W
Second Line	:	STE 102
City	:	BRICK
State	:	NJ
Zip	:	08724-3009
Country	:	US
Telephone Number	:	732-836-9300
Fax Number	:	732-836-9305

Provider Business Practice Location Address
First Line	:	1608 ROUTE 88 W
Second Line	:	STE 102
City	:	BRICK
State	:	NJ
Zip	:	08724-3009
Country	:	US
Telephone Number	:	732-836-9300
Fax Number	:	732-836-9305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/16/2008

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Directions to “ DUC THI TRAN M.D.” Practice Location

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