Healthcare Provider Details

I. General information

NPI: 1235313933
Provider Name (Legal Business Name): MICHAEL C. TRAHOS, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 GOLDSBORO RD
FALLS CHURCH VA
22042-4108
US

IV. Provider business mailing address

6613 GOLDSBORO RD
FALLS CHURCH VA
22042-4108
US

V. Phone/Fax

Practice location:
  • Phone: 703-998-4913
  • Fax: 703-931-8171
Mailing address:
  • Phone: 703-998-4913
  • Fax: 703-931-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0102035626
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0102035626
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL C TRAHOS
Title or Position: DIRECTOR/MEMBER
Credential: D.O.
Phone: 703-998-4913