Healthcare Provider Details

I. General information

NPI: 1689171092
Provider Name (Legal Business Name): NICOLE TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 WASHINGTON BLVD
STAMFORD CT
06902-2419
US

IV. Provider business mailing address

2890 MAIN ST STE 2A
STRATFORD CT
06614-4980
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-1000
  • Fax:
Mailing address:
  • Phone: 203-276-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number69280
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: