Provider Demographics
NPI:1235313933
Name:MICHAEL C. TRAHOS, D.O.
Entity Type:Organization
Organization Name:MICHAEL C. TRAHOS, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:703-998-4913
Mailing Address - Street 1:6613 GOLDSBORO RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4108
Mailing Address - Country:US
Mailing Address - Phone:703-998-4913
Mailing Address - Fax:703-931-8171
Practice Address - Street 1:6613 GOLDSBORO RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4108
Practice Address - Country:US
Practice Address - Phone:703-998-4913
Practice Address - Fax:703-931-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102035626207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD84002Medicare UPIN
VA164811Medicare PIN