Provider Demographics
NPI:1376146241
Name:CABLE, TREVOR NOLAN
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:NOLAN
Last Name:CABLE
Suffix:
Gender:M
Credentials:
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 5271
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5204
Mailing Address - Country:US
Mailing Address - Phone:757-713-3433
Mailing Address - Fax:
Practice Address - Street 1:622 RALEIGH AVE APT 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2034
Practice Address - Country:US
Practice Address - Phone:757-713-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program