Provider Demographics
NPI:1790751733
Name:TRZPUC, TRENT DAMIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:DAMIAN
Last Name:TRZPUC
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 1:302 UNIVERSITY PKWY
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6302
Mailing Address - Country:US
Mailing Address - Phone:803-641-5172
Mailing Address - Fax:803-641-5140
Practice Address - Street 1:302 UNIVERSITY PKWY
Practice Address - Street 2:AIKEN REGIONAL MEDICAL CENTERS PATHOLOGY DEPT.
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6302
Practice Address - Country:US
Practice Address - Phone:803-641-5172
Practice Address - Fax:803-641-5140
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44945-020207ZP0102X
SCTL30472207ZP0102X
SC30472207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30472OtherSOUTH CAROLINA MEDICAL LICENSE PERMANENT
SCTL30472OtherSOUTH CAROLINA MEDICAL LICENSE TEMPORARY
WI34614900Medicaid
SC304726Medicaid
WI000767195Medicare PIN
SC30472OtherSOUTH CAROLINA MEDICAL LICENSE PERMANENT
SCAA2479E360Medicare PIN