Provider Demographics
NPI:1114287083
Name:QUANG TRUC TRAN, MD, PC
Entity Type:Organization
Organization Name:QUANG TRUC TRAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:TRUC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-538-6248
Mailing Address - Street 1:7297 LEE HWY STE E
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1707
Mailing Address - Country:US
Mailing Address - Phone:703-538-6248
Mailing Address - Fax:703-538-6403
Practice Address - Street 1:7297 LEE HWY STE E
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1707
Practice Address - Country:US
Practice Address - Phone:703-538-6248
Practice Address - Fax:703-538-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00101041832302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006068227Medicaid
281798OtherAMERIGROUP
530080001OtherCARE FIRST BLUE CROSS BLUE SHIELD OF DC
054861OtherANTHEM HEALTH KEEPER
054861OtherANTHEM HEALTH KEEPER
281798OtherAMERIGROUP