Provider Demographics
NPI:1750494597
Name:TRENT, JEANIE L (MD)
Entity type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:L
Last Name:TRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-747-5770
Mailing Address - Fax:804-747-5746
Practice Address - Street 1:7700 E PARHAM ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4301
Practice Address - Country:US
Practice Address - Phone:804-747-5770
Practice Address - Fax:804-747-5746
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042195207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5832772Medicaid
VA284900OtherANTHEM
VA284900OtherANTHEM
VA110008297Medicare PIN