Provider Demographics
NPI:1093842619
Name:HILES, TRENTON LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:LEE
Last Name:HILES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-824-1824
Mailing Address - Fax:508-880-9857
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-824-1824
Practice Address - Fax:508-880-9857
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1617363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1959Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MAP93099Medicare UPIN