Provider Demographics
NPI:1942599634
Name:UYEMURA, TREVOR MICHIO
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:MICHIO
Last Name:UYEMURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 WAPLES MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7406
Mailing Address - Country:US
Mailing Address - Phone:703-246-9560
Mailing Address - Fax:703-246-9564
Practice Address - Street 1:11211 WAPLES MILL RD
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7406
Practice Address - Country:US
Practice Address - Phone:703-246-9560
Practice Address - Fax:703-246-9564
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259708207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease