Provider Demographics
NPI:1699887489
Name:TRAN, THOMAS T (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W. MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-228-2212
Mailing Address - Fax:276-228-7835
Practice Address - Street 1:680 W. MONROE ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-2212
Practice Address - Fax:276-228-7835
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000956213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099913000Medicaid
VA9301402Medicaid
AL92387439OtherBCBS
PATR661755OtherBCBS
700021290OtherCIGNA NATIONAL
4315920001OtherDME
U50085OtherUNIVERSAL MEDICARE
021290OtherCIGNA RICHMOND VA
VA100677OtherBCBS
WV100678OtherBCBS
P9434OtherTRIGON BCBS KEY ADVANTAGE
PA2700429OtherUNITED HEALTH CARE
4315920001Medicare NSC