MEDICARE: DR. TREVOR WHITESIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	22538	MD

General Provider Information

NPI Number	:	1659771236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR WHITESIDE

Provider Business Mailing Address
First Line	:	117 HESS RD
Second Line	:
City	:	GRASONVILLE
State	:	MD
Zip	:	21638-1304
Country	:	US
Telephone Number	:	410-829-0286
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 S CHERRY GROVE AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4244
Country	:	US
Telephone Number	:	443-482-3981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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