Provider Demographics
NPI:1023128014
Name:LE, TRU VAN (MD)
Entity type:Individual
Prefix:DR
First Name:TRU
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6404 SEVEN CORNERS PL STE F
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2033
Mailing Address - Country:US
Mailing Address - Phone:703-241-5695
Mailing Address - Fax:703-237-9896
Practice Address - Street 1:6404 SEVEN CORNERS PL STE F
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2033
Practice Address - Country:US
Practice Address - Phone:703-241-5695
Practice Address - Fax:703-237-9896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA281005OtherAMERIGROUP ID NUMBER
VA201878OtherHEALTHKEEPER PLUS
VA201878OtherTRIGON BCBS ID NUMBER
VA869239OtherOPTIMUM CHOICE/MDIPA
VA5851116OtherAETNA ID NUMBER
VA2154001OtherCAREFIRST BCBS
VAP132Medicare UPIN