Provider Demographics
NPI:1609342872
Name:TRUONG, ALEX (PA)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7432 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3013
Mailing Address - Country:US
Mailing Address - Phone:703-658-7060
Mailing Address - Fax:703-658-3150
Practice Address - Street 1:7432 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3013
Practice Address - Country:US
Practice Address - Phone:703-658-7060
Practice Address - Fax:703-658-3150
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-006442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant