MEDICARE: MARTIN TRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E1976963	OTHER		EMT

General Provider Information

NPI Number	:	1598223091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN TRAN

Provider Business Mailing Address
First Line	:	2405 NORMANDY SQUARE PL APT B
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-6132
Country	:	US
Telephone Number	:	240-707-5211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 NORMANDY SQUARE PL APT B
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-6132
Country	:	US
Telephone Number	:	240-707-5211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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Directions to “ MARTIN TRAN ” Practice Location

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