Provider Demographics
NPI:1487946505
Name:TRAN, THAO-TAM (DO)
Entity type:Individual
Prefix:DR
First Name:THAO-TAM
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:210 YORKTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:215-600-4590
Mailing Address - Fax:
Practice Address - Street 1:2700 CLEMENS RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-4202
Practice Address - Country:US
Practice Address - Phone:215-607-7256
Practice Address - Fax:215-258-8999
Is Sole Proprietor?:No
Enumeration Date:2011-05-08
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSO16967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA364759LIMMedicare PIN