Individual
THOMAS C TREVORROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
119 PROFESSIONAL CTR, 1265 WAYNE AVENUE, SUITE 203, INDIANA, PA 15701-3501
(724) 463-0286
(724) 463-3542
Mailing address
119 PROFESSIONAL CTR, 1265 WAYNE AVENUE, SUITE 203, INDIANA, PA 15701-3501
(724) 463-0286
(724) 463-3542
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD049389L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014147820002
MEDICAL ASSISTANCE PROVID
PA
01
—
1040831
GATEWAY PROVIDER
PA
01
—
72340
MED PLUS
PA
01
—
735637
BLUE SHIELD PROVIDER
PA
01
—
735637-L3D
BLUE SHIELD PROVIDER
PA
Enumeration date
08/16/2005
Last updated
08/27/2007
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