Healthcare Provider Details

I. General information

NPI: 1538140306
Provider Name (Legal Business Name): DONALD TRUMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 GALLOWS RD
FAIRFAX VA
22031-4872
US

IV. Provider business mailing address

3225 GALLOWS RD
FAIRFAX VA
22031-4872
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-0221
  • Fax: 571-472-0241
Mailing address:
  • Phone: 571-472-0221
  • Fax: 571-472-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101258401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: