Provider Demographics
NPI:1851608020
Name:TRAN, MICHELLE T (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1480 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3093
Practice Address - Country:US
Practice Address - Phone:540-948-6743
Practice Address - Fax:540-948-4527
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL1428207Q00000X
VA0116023291207Q00000X
SCTL1428207Q00000X
VA0102203237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7124OtherMEDICARE
SCFQC048Medicaid
SCFQC048Medicaid