Healthcare Provider Details

I. General information

NPI: 1013595016
Provider Name (Legal Business Name): JORGE ANDRES TREVINO CALDERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

5309 CONNECTICUT AVE NW APT 1
WASHINGTON DC
20015-1803
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5000
  • Fax:
Mailing address:
  • Phone: 617-407-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD600005832
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: