=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124375365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAN MEDICAL PRACTICE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2012
-----------------------------------------------------
Last Update Date | 08/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1770 LONG POND RD SUITE 201
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14606-4057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-247-8460
-----------------------------------------------------
Fax | 585-247-8462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1770 LONG POND RD SUITE 201
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14606-4057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-247-8460
-----------------------------------------------------
Fax | 585-247-8462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MBR
-----------------------------------------------------
Name | VU TRAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 585-247-8460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 222275NY
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------