Healthcare Provider Details

I. General information

NPI: 1720574569
Provider Name (Legal Business Name): VALLEY GEROPSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123B CRYSTAL SPRING AVE SW
ROANOKE VA
24014-2413
US

IV. Provider business mailing address

2123B CRYSTAL SPRING AVE SW
ROANOKE VA
24014-2413
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-3136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID TRINKLE
Title or Position: OWNER
Credential: MD
Phone: 540-266-1336