1033179122 NPI number — DR. LUAN TRAN MD

Table of content: DR. LUAN TRAN MD (NPI 1033179122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033179122 NPI number — DR. LUAN TRAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
LUAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAN
Provider Other First Name:
LUAN
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033179122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2245 GATEWAY ACCESS POINTE
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-510-8900
Provider Business Mailing Address Fax Number:
919-510-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2245 GATEWAY ACCESS PT
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-510-8900
Provider Business Practice Location Address Fax Number:
919-510-8977
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  200301302 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 202K00000X , with the licence number: 200301302 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1548206022 . This is a "MEDICARE RAILROAD INDIVIDUAL PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DE0112 . This is a "GROUP MEDICARE RAILROAD PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2323842 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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