Healthcare Provider Details

I. General information

NPI: 1801432992
Provider Name (Legal Business Name): BRIAN TRAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE BUILDING A, ROOM 584
BALTIMORE MD
21224
US

IV. Provider business mailing address

4940 EASTERN AVE RM 588
BALTIMORE MD
21224-2735
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-7584
  • Fax:
Mailing address:
  • Phone: 703-618-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR241730
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: