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General NPI Number Information
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NPI Number | 1003001587
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Entity Type | Individual
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Provider Name | MARY CHAU TRAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 400 SAYBROOK RD STE 205
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4775
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Country | US
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Telephone | 888-344-0007
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Fax | 860-343-1004
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Provider Business Mailing Address
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Address Line | 280 SAND HILL RD
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4533
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Country | US
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Telephone | 985-413-0732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 012657
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3091
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License Number State | CT
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