Provider Demographics
NPI:1730743394
Name:TRAN, ANTHONY PHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PHAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9 WALTER SEYFERT WAY
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1868
Mailing Address - Country:US
Mailing Address - Phone:617-642-6229
Mailing Address - Fax:
Practice Address - Street 1:199 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3926
Practice Address - Country:US
Practice Address - Phone:617-313-1480
Practice Address - Fax:617-313-1479
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10144262084N0400X, 2084E0001X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS88291395OtherMASSACHUSETTS LICENSE NUMBER