Provider Demographics
NPI:1952381451
Name:TRAN, KHOA Q (MD)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:Q
Last Name:TRAN
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 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-723-9751
Mailing Address - Fax:
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-723-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherGREAT VALLEY HEALTH
PA0019086840001Medicaid
PA062083N2PMedicare ID - Type UnspecifiedGREAT VALLEY HEALTH-AIP
H69974Medicare UPIN
PA232359401OtherGREAT VALLEY HEALTH