Healthcare Provider Details

I. General information

NPI: 1821891904
Provider Name (Legal Business Name): TREVENA ANTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

395 W 12TH AVE
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-0768
  • Fax:
Mailing address:
  • Phone: 614-366-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1821891904
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: