Provider Demographics
NPI:1972699205
Name:DESOUZA, TREVOR G (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:G
Last Name:DESOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:25 LINDSLEY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4455
Practice Address - Country:US
Practice Address - Phone:973-993-8777
Practice Address - Fax:973-993-8577
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA048018002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0983101Medicaid
NJE53618Medicare UPIN
077356Medicare PIN
NJ0983101Medicaid