MEDICARE: BRANDON TRUONG

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1275137499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON TRUONG

Provider Business Mailing Address
First Line	:	320 MONTGOMERY ST APT 23
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2531
Country	:	US
Telephone Number	:	315-373-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 MONTGOMERY ST APT 23
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13202-2531
Country	:	US
Telephone Number	:	315-373-6463
Fax Number	:

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

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ BRANDON TRUONG ” Practice Location

Language	Start Address	Practice Location

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