Healthcare Provider Details

I. General information

NPI: 1629197363
Provider Name (Legal Business Name): DANIELLE TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST SUITE 9
NORWAY ME
04268-5645
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-8766
  • Fax: 207-743-1579
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number015390
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: