Provider Demographics
NPI:1609819689
Name:TREVLYN, DEAN WILLAIM (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:WILLAIM
Last Name:TREVLYN
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 1:2004 SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3511
Mailing Address - Country:US
Mailing Address - Phone:610-353-0800
Mailing Address - Fax:610-359-1686
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-353-0800
Practice Address - Fax:610-359-1686
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044626E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF23385Medicare UPIN