Provider Demographics
NPI:1043216179
Name:TRAN, CAROL (PA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4479
Mailing Address - Country:US
Mailing Address - Phone:505-843-8758
Mailing Address - Fax:505-843-8759
Practice Address - Street 1:3810 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4479
Practice Address - Country:US
Practice Address - Phone:058-438-7585
Practice Address - Fax:505-843-8759
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2016-0057363AM0700X
TXPA04560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX840878OtherBCBS
P00298578OtherRAILROAD MEDICARE
P96464Medicare UPIN
TXP00298578Medicare PIN
P00298578OtherRAILROAD MEDICARE
TX8G2256Medicare PIN