Healthcare Provider Details

I. General information

NPI: 1326672916
Provider Name (Legal Business Name): TRUNG THANH TRAN APRN. CRNP. NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 07/22/2022
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S PACA ST
BALTIMORE MD
21201-1771
US

IV. Provider business mailing address

29 S PACA ST
BALTIMORE MD
21201-1771
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-2100
  • Fax: 410-685-1973
Mailing address:
  • Phone: 667-214-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145149
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: