Basic Information
| Provider Information | |||||||||
| NPI: | 1811981475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12110 SUNSET HILLS RD | ||||||||
| Address2: | LOWER LEVER 20 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038341473 | ||||||||
| FaxNumber: | 7033187463 | ||||||||
| Practice Location | |||||||||
| Address1: | 12110 SUNSET HILLS RD | ||||||||
| Address2: | LOWER LEVEL 20 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038341473 | ||||||||
| FaxNumber: | 7033187463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101235718 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010191912 | 05 | VA | MEDICAID |