Provider Demographics
NPI:1891743159
Name:POOLE, TREVOR WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:WARD
Last Name:POOLE
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 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-783-6997
Mailing Address - Fax:419-782-6103
Practice Address - Street 1:1250 RALSTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5309
Practice Address - Country:US
Practice Address - Phone:419-783-6997
Practice Address - Fax:419-782-6103
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23024174400000X
OH35.132964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304082Medicaid
SCGP1384Medicaid
OHH650150OtherMEDICARE