Provider Demographics
NPI:1679544944
Name:VANTRAN, ALICIA G (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:G
Last Name:VANTRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:G
Other - Last Name:VARELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3204 WINDSOR RDG S
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1435
Mailing Address - Country:US
Mailing Address - Phone:703-946-1732
Mailing Address - Fax:
Practice Address - Street 1:1 TRACEN
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692
Practice Address - Country:US
Practice Address - Phone:757-856-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCBV7257391Medicare UPIN