Provider Demographics
NPI:1578803961
Name:TREVISANI, THOMAS PATRICK SR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:TREVISANI
Suffix:SR
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 1628
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-1628
Mailing Address - Country:US
Mailing Address - Phone:407-629-4100
Mailing Address - Fax:
Practice Address - Street 1:2802 ALOMA AVE
Practice Address - Street 2:STE 101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3532
Practice Address - Country:US
Practice Address - Phone:407-629-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30449208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery