Provider Demographics
NPI:1124002043
Name:TRENBATH, RICHARD STOCKTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STOCKTON
Last Name:TRENBATH
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 1049
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4049
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:211 MERCHANTS WALK
Practice Address - Street 2:SHOPPING CENTER
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1901
Practice Address - Country:US
Practice Address - Phone:304-872-9455
Practice Address - Fax:304-872-9456
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12758207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022256Medicaid
WV002684077OtherHIGHMARK BCBS
WV0053183000Medicaid
WVWV0986A760Medicare PIN
WV002684077OtherHIGHMARK BCBS
WV2017821Medicare PIN
WVF25428Medicare UPIN