Healthcare Provider Details

I. General information

NPI: 1871598110
Provider Name (Legal Business Name): PETER SHELTON TRENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N LA PLATA CT
LA PLATA MD
20646-4283
US

IV. Provider business mailing address

PO BOX 2188
LA PLATA MD
20646-2188
US

V. Phone/Fax

Practice location:
  • Phone: 301-392-3330
  • Fax: 301-392-3950
Mailing address:
  • Phone: 301-392-3330
  • Fax: 301-392-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0046821
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD21013
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101051792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: