Provider Demographics
NPI:1851491021
Name:GUY TRENGOVE-JONES, M.D., P.C.
Entity Type:Organization
Organization Name:GUY TRENGOVE-JONES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DLUBALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-423-2166
Mailing Address - Street 1:PO BOX 9375
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-0375
Mailing Address - Country:US
Mailing Address - Phone:757-423-2166
Mailing Address - Fax:757-423-2285
Practice Address - Street 1:100 KINGSLEY LN
Practice Address - Street 2:SUITE 302
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4604
Practice Address - Country:US
Practice Address - Phone:757-423-2166
Practice Address - Fax:757-423-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035886208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
240004633OtherMEDICARE RAILROAD
VA006900691Medicaid
B09586Medicare UPIN
VA006900691Medicaid