Provider Demographics
NPI:1184476368
Name:DAVENPORT, TRINA N
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:N
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 HENRY HARFORD DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1130
Mailing Address - Country:US
Mailing Address - Phone:443-854-8835
Mailing Address - Fax:443-835-1952
Practice Address - Street 1:22 W PENNSYLVANIA AVE STE 405
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5003
Practice Address - Country:US
Practice Address - Phone:410-832-3715
Practice Address - Fax:410-832-3163
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02149251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health