Provider Demographics
NPI:1891236154
Name:TRAN, LY (DO)
Entity type:Individual
Prefix:
First Name:LY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5506
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:321-841-1302
Practice Address - Street 1:2320 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5506
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:321-841-1302
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-02844207R00000X
FLOS17789207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124040300Medicaid