Provider Demographics
NPI:1720027436
Name:TROTTER, MARVIN GHENT (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:GHENT
Last Name:TROTTER
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 1:275 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4531
Mailing Address - Country:US
Mailing Address - Phone:707-462-7900
Mailing Address - Fax:707-462-7947
Practice Address - Street 1:275 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4531
Practice Address - Country:US
Practice Address - Phone:707-462-7900
Practice Address - Fax:707-462-7947
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42597207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G425971Medicare ID - Type Unspecified
CAA49033Medicare UPIN