Provider Demographics
NPI:1144338997
Name:TRAN, TUONG Q (MD)
Entity type:Individual
Prefix:
First Name:TUONG
Middle Name:Q
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:305 BELMONT STREET
Mailing Address - Street 2:WORCESTER STATE HOSPITAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604
Mailing Address - Country:US
Mailing Address - Phone:508-368-3498
Mailing Address - Fax:508-363-1512
Practice Address - Street 1:305 BELMONT STREET
Practice Address - Street 2:WORCESTER STATE HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-368-3498
Practice Address - Fax:508-363-1512
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA580332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF17726Medicare UPIN
MAY02688Medicare PIN