Provider Demographics
NPI:1508070202
Name:TREVEJO, JOSE MIGUEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:TREVEJO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ABBEY RD
Mailing Address - Street 2:3
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1203
Mailing Address - Country:US
Mailing Address - Phone:617-258-3438
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:GB
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223272207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease