MEDICARE: DR. ALICIA G. VANTRAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11692	PR

General Provider Information

NPI Number	:	1679544944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA G. VANTRAN M.D.

Provider Business Mailing Address
First Line	:	3204 WINDSOR RDG S
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-1435
Country	:	US
Telephone Number	:	703-946-1732
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRACEN
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692
Country	:	US
Telephone Number	:	757-856-2306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	12/05/2023

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