Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 16391 | MD |
Y | 213EG0000X | General Practice | 16391 | MD |
NPI | 1003335506 |
---|---|
Provider Name | Dr. Trevor Frederick Maples |
First Address | Frostburg, MD 21532-1397 |
Second Address | Frostburg, MD 21532-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 15/09/2017 |