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General NPI Number Information
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NPI Number | 1487278875
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Entity Type | Individual
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Provider Name | TREVOR DOUGLAS VAN DE WATER MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 260 ROBESON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5573
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Country | US
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Telephone | 910-984-8311
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Fax | 919-787-7247
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Provider Business Mailing Address
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Address Line | 3801 WAKE FOREST RD STE 210
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City | RALEIGH
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State | NC
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Zip | 27609-6864
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Country | US
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Telephone | 919-787-7246
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Fax | 919-787-7247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11977
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | D0099403
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2025-01885
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License Number State | NC
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