MEDICARE: DANIELLE CHRISTINE TRAN PA

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	363A00000X	Physician Assistant	0010-09178	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010-09178	OTHER	NC	NC MEDICAL LICENSE
2	1134084	OTHER	NC	PA-C LICENSE

General Provider Information

NPI Number	:	1235674276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE CHRISTINE TRAN PA

Provider Business Mailing Address
First Line	:	PO BOX 601843
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 BEREWICK TOWN CENTER DR STE C&D
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6733
Country	:	US
Telephone Number	:	980-337-4652
Fax Number	:	980-337-4653

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

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	09/26/2024

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Directions to “ DANIELLE CHRISTINE TRAN PA” Practice Location

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