Individual
LISA TREVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10212 GOVERNOR LANE BLVD, SUITE1004, WILLIAMSPORT, MD 21795-4086
(301) 733-4200
(301) 223-7121
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0044644
MD
207L00000X
Anesthesiology Physician
MD433370
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50090037
CAPITAL BC
PA
01
—
KBC1CH
CAREFIRST BCBS
MD
01
—
S417 0002
CAREFIRST BCBS
DC
Enumeration date
06/12/2006
Last updated
08/15/2016
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