Provider Demographics
NPI:1942361530
Name:JOCELYN D. TRENT, M.D., F.A.A.P.
Entity Type:Organization
Organization Name:JOCELYN D. TRENT, M.D., F.A.A.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:DEJESUS
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-878-2233
Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-878-2233
Mailing Address - Fax:703-878-2254
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-878-2233
Practice Address - Fax:703-878-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6730515Medicaid