Provider Demographics
NPI:1326672916
Name:TRAN, TRUNG THANH (APRN CRNP NP-C)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:APRN CRNP NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1771
Mailing Address - Country:US
Mailing Address - Phone:667-214-2100
Mailing Address - Fax:
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:667-214-2100
Practice Address - Fax:410-685-1973
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily