Provider Demographics
NPI:1043372147
Name:TRAN, JOHANNA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELIZABETH
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:ELIZABETH
Other - Last Name:CRYTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1832 BELLAMY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8002
Mailing Address - Country:US
Mailing Address - Phone:804-342-4335
Mailing Address - Fax:804-342-4316
Practice Address - Street 1:8254 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-342-4335
Practice Address - Fax:804-342-4316
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234899207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01043372147Medicaid
VA003801R54Medicare ID - Type Unspecified
VA014039T41Medicare PIN
VAI01359Medicare UPIN