Healthcare Provider Details

I. General information

NPI: 1336133974
Provider Name (Legal Business Name): ANN ANH TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANH THUY THI TRAN

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 COACHWAY
ANNAPOLIS MD
21401-6477
US

IV. Provider business mailing address

11995 SINGLETREE LN SUITE 500
EDEN PRAIRIE MN
55344-5347
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 612-294-4903
Mailing address:
  • Phone: 952-595-1301
  • Fax: 612-294-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35718
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD43088
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042-0010957
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: