Provider Demographics
NPI:1821288143
Name:OWEN, TREVOR MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:MARSHALL
Last Name:OWEN
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 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251827207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821288143OtherVA PREMIER
VA1821288143OtherUNITED HEALTHCARE
VA1821288143OtherAETNA
VA1821288143OtherGATEWAY
VA1821288143Medicaid
VA1321288143OtherANTHEM
VA1821288143OtherHEALTHKEEPERS PLUS
VA1821288143OtherVIRGINIA HEALTH NETWORK
VA1821288143OtherHEALTHKEEPERS
VA1821288143OtherOPTIMA HEALTH PLAN
VA3810023893OtherMEDICAID OF WEST VIRGINIA
VA1821288143OtherMAJESTACARE
VA1821288143OtherCIGNA
VA1821288143OtherINTOTAL
VA540506332108OtherTRICARE/CHAMPUS
VAP01115341OtherRAILROAD MEDICARE
VA1821288143OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1821288143OtherHUMANA MEDICARE
VA371194700OtherBLACK LUNG
VA1821288143OtherUMWA
VA1821288143OtherVA PREMIER