Healthcare Provider Details

I. General information

NPI: 1932360179
Provider Name (Legal Business Name): THACH-GIAO TRUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TAUSSIG CANCER INSTITUTE 10201 CARNEGIE AVE/CA-60
CLEVELAND OH
44195-3733
US

IV. Provider business mailing address

630 W 168TH ST BOX 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-4623
  • Fax: 216-444-9464
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA112693
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.149364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: