Healthcare Provider Details

I. General information

NPI: 1285787341
Provider Name (Legal Business Name): TREVOR ASHTON ELLISON M.D., PH.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS STREET SUITE 7107
BALTIMORE MD
21287-4618
US

IV. Provider business mailing address

3000 ARLINGTON AVE STOP 1108
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9780
  • Fax:
Mailing address:
  • Phone: 419-383-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.134693
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT4123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: