Provider Demographics
NPI:1538140306
Name:TRUMP, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:TRUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 GALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4872
Mailing Address - Country:US
Mailing Address - Phone:571-472-0221
Mailing Address - Fax:571-472-0241
Practice Address - Street 1:3225 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4872
Practice Address - Country:US
Practice Address - Phone:571-472-0221
Practice Address - Fax:571-472-0241
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258401207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB57213Medicare UPIN
NYDD0944Medicare ID - Type Unspecified
NY02238571Medicare ID - Type Unspecified