Healthcare Provider Details

I. General information

NPI: 1124491576
Provider Name (Legal Business Name): VIRGINIA TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW STE. NA1177
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

6327 BEACHWAY DR
FALLS CHURCH VA
22044-1510
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-4848
  • Fax:
Mailing address:
  • Phone: 703-347-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031192
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005113
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: