1568511939 NPI number — DR. NHU LE TRAN MD

Table of content: DR. NHU LE TRAN MD (NPI 1568511939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568511939 NPI number — DR. NHU LE TRAN MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568511939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10026 OLD OCEAN CITY BLVD
Provider Second Line Business Mailing Address:
BUILDING ONE
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-629-6541
Provider Business Mailing Address Fax Number:
410-629-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38394 DUPONT BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
SELBYVILLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-389-3900
Provider Business Practice Location Address Fax Number:
302-436-6328
Provider Enumeration Date:
01/08/2007

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: 171100000X , with the licence number:  186034 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A186034 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D0066708 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: C1-0009318 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 186034 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01345188 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0066708 . This is a "MARYLAND MEDICAL STATE BOARD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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