Provider Demographics
NPI:1073770905
Name:TREHERNE, ANNYCE CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:ANNYCE
Middle Name:CHRISTINA
Last Name:TREHERNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2478
Mailing Address - Country:US
Mailing Address - Phone:757-838-8525
Mailing Address - Fax:757-838-8527
Practice Address - Street 1:2207 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2478
Practice Address - Country:US
Practice Address - Phone:757-838-8525
Practice Address - Fax:757-838-8527
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0438003934Medicaid