Provider Demographics
NPI:1003001587
Name:TRAN, MARY CHAU (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHAU
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4533
Mailing Address - Country:US
Mailing Address - Phone:985-413-0732
Mailing Address - Fax:
Practice Address - Street 1:400 SAYBROOK RD STE 205
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4775
Practice Address - Country:US
Practice Address - Phone:888-344-0007
Practice Address - Fax:860-343-1004
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012657363AS0400X
CT3091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400002540Medicare PIN