Healthcare Provider Details

I. General information

NPI: 1952503161
Provider Name (Legal Business Name): GUY TRENGOVE-JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGSLEY LN SUITE 302
NORFOLK VA
23505-4604
US

IV. Provider business mailing address

PO BOX 9375
NORFOLK VA
23505-0375
US

V. Phone/Fax

Practice location:
  • Phone: 757-423-2166
  • Fax: 757-423-2285
Mailing address:
  • Phone: 757-423-2166
  • Fax: 757-423-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101035886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: