=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902829807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH TRAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 S 54TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19143-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-748-3100
-----------------------------------------------------
Fax | 215-748-1586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 W ELM ST SUITE 100
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-567-6967
-----------------------------------------------------
Fax | 610-567-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD063663L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------