MEDICARE: DR. PETER SHELTON TRENT MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	D0046821	MD
2	207X00000X	Orthopaedic Surgery Physician	MD21013	DC
3	207X00000X	Orthopaedic Surgery Physician	0101051792	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1871598110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER SHELTON TRENT MD

Provider Business Mailing Address
First Line	:	PO BOX 2188
Second Line	:
City	:	LA PLATA
State	:	MD
Zip	:	20646-2188
Country	:	US
Telephone Number	:	301-392-3330
Fax Number	:	301-392-3950

Provider Business Practice Location Address
First Line	:	16 N LA PLATA CT
Second Line	:
City	:	LA PLATA
State	:	MD
Zip	:	20646-4283
Country	:	US
Telephone Number	:	301-392-3330
Fax Number	:	301-392-3950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/07/2013

1101 MEDICARE CTR. BLVD. , HOSPITALIST DEPARTMENT
MARRERO, LA
70072

Practice Phone: 504-349-1656
Practice Fax: 504-349-1933