Provider Demographics
NPI:1962417717
Name:TRAHAN, KATHERINE MENK (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MENK
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:GRACE
Other - Last Name:MENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2170 VITTORIO LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9678
Mailing Address - Country:US
Mailing Address - Phone:434-962-9034
Mailing Address - Fax:
Practice Address - Street 1:2800 BLUE RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6476
Practice Address - Country:US
Practice Address - Phone:919-784-7874
Practice Address - Fax:919-784-2708
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241803208600000X
NC2017-02317208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90305Medicare UPIN
VA016065M54Medicare PIN
VAP00466951Medicare PIN