Basic Information
| Provider Information | |||||||||
| NPI: | 1265516686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DETRANE | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1031 CARE WAY | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224018425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403717600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1031 CARE WAY | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224018425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403717600 | ||||||||
| FaxNumber: | 5403702046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0101041848 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 010272033 | 05 | VA | MEDICAID | 10806 | 01 | VA | SENTARA | OTHER | 168828 | 01 | VA | ANTHEM BCBS | OTHER | 101272033 | 05 | VA | MEDICAID | 250917 | 01 | VA | SOUTHERN HEALTH | OTHER | 0001 | 01 | VA | CAREFIRST | OTHER | 3730484 | 01 | VA | AETNA HMO | OTHER | 477497 | 01 | VA | MAMSI/UNITED HEALTHCARE | OTHER | 100006739 | 01 | VA | RAILROAD MEDICARE | OTHER | 201718482011 | 01 | VA | CHAMPUS/TRICARE | OTHER | 20502 | 01 | VA | VMA S/HEALTH CARENET | OTHER | 4598039 | 01 | VA | AETNA | OTHER |