Provider Demographics
NPI:1699782474
Name:DU, DOANTRANG (MD)
Entity type:Individual
Prefix:
First Name:DOANTRANG
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-222-4474
Practice Address - Fax:732-222-4472
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06953300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024384Medicaid
NJG75086Medicare UPIN
NJ075773Medicare PIN