Healthcare Provider Details

I. General information

NPI: 1962417717
Provider Name (Legal Business Name): KATHERINE MENK TRAHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATHERINE GRACE MENK

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/02/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 300
RALEIGH NC
27607-6476
US

IV. Provider business mailing address

2170 VITTORIO LN
APEX NC
27502-9678
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax: 919-784-2708
Mailing address:
  • Phone: 434-962-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101241803
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017-02317
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: