Provider Demographics
NPI:1588600332
Name:TRAN, LUCAS VAN (MD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUC
Other - Middle Name:VAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0221
Mailing Address - Country:US
Mailing Address - Phone:910-323-1016
Mailing Address - Fax:910-323-0978
Practice Address - Street 1:101 ROBESON STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5520
Practice Address - Country:US
Practice Address - Phone:910-323-1016
Practice Address - Fax:910-323-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC274092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983695Medicaid
4584679OtherAETNA
NC83695OtherBCBS
E14075Medicare UPIN
4584679OtherAETNA