Provider Demographics
NPI:1093711038
Name:CARLYLE, TRENTON ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:ANDREW
Last Name:CARLYLE
Suffix:
Gender:M
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:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:
Practice Address - Street 1:23530 KINGSLAND BLVD STE 302
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7466
Practice Address - Country:US
Practice Address - Phone:281-733-2863
Practice Address - Fax:713-965-7633
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01085058OtherRAILROAD
TX146636902Medicaid
TX146636903Medicaid
TX146636904Medicaid
TX146636901Medicaid
TX146636905Medicaid
TX146636910Medicaid
TXTXB143881Medicare PIN
TXTXB143879Medicare PIN
TXTXB143882Medicare PIN
TX146636901Medicaid
TXTXB143883Medicare PIN