Provider Demographics
NPI:1174580864
Name:CUONG, TRAN TRONG (MD)
Entity type:Individual
Prefix:DR
First Name:TRAN
Middle Name:TRONG
Last Name:CUONG
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 1:4534 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1533
Mailing Address - Country:US
Mailing Address - Phone:703-683-6840
Mailing Address - Fax:
Practice Address - Street 1:4534 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1533
Practice Address - Country:US
Practice Address - Phone:703-683-6840
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5616603Medicaid
VA159552Medicare ID - Type Unspecified
VAC88022Medicare UPIN