Basic Information
Provider Information | |||||||||
NPI: | 1225381783 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TRAN | ||||||||
FirstName: | MASEO | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TRAN | ||||||||
OtherFirstName: | MICHELLE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 675 PARAMOUNT DR | ||||||||
Address2: | SUITE 203 | ||||||||
City: | RAYNHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 027675416 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5088800012 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 675 PARAMOUNT DR | ||||||||
Address2: | SUITE 203 | ||||||||
City: | RAYNHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 027675416 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5088800012 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/22/2012 | ||||||||
LastUpdateDate: | 10/22/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA4549 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
No ID Information.