MEDICARE: THERESA TRAN M.D.

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	207Y00000X	Otolaryngology Physician	220818	NY

General Provider Information

NPI Number	:	1578564407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA TRAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 95000-2434
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-2434
Country	:	US
Telephone Number	:	212-844-8025
Fax Number	:	212-844-8769

Provider Business Practice Location Address
First Line	:	10 UNION SQ E
Second Line	:	SUITE 4J
City	:	NEW YORK
State	:	NY
Zip	:	10003-3314
Country	:	US
Telephone Number	:	212-844-8025
Fax Number	:	212-844-8769

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/19/2022

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