Healthcare Provider Details

I. General information

NPI: 1558501320
Provider Name (Legal Business Name): BAO CHAU MINH TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 DURHAM AVE SUITE 1A BLD 6
SOUTH PLAINFIELD NJ
07080-2546
US

IV. Provider business mailing address

590 HARTFORD DR
NUTLEY NJ
07110-3948
US

V. Phone/Fax

Practice location:
  • Phone: 732-338-0228
  • Fax:
Mailing address:
  • Phone: 732-718-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08559100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA08559100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: