Provider Demographics
NPI:1588865026
Name:TRAIL, DEANNA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LYNNE
Last Name:TRAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 NATHANIELS GREEN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-7505
Mailing Address - Country:US
Mailing Address - Phone:757-879-4725
Mailing Address - Fax:757-258-3271
Practice Address - Street 1:3096 NATHANIELS GRN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-7505
Practice Address - Country:US
Practice Address - Phone:757-879-4725
Practice Address - Fax:757-258-3271
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine