Provider Demographics
NPI:1831169523
Name:TRENT, CAROL GLENN JR (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:GLENN
Last Name:TRENT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:581 LEROY GEORGE DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8084
Mailing Address - Country:US
Mailing Address - Phone:828-452-8378
Mailing Address - Fax:828-452-8326
Practice Address - Street 1:581 LEROY GEORGE DR
Practice Address - Street 2:SUITE 380
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8084
Practice Address - Country:US
Practice Address - Phone:828-452-8378
Practice Address - Fax:828-452-8326
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN38020207X00000X
NC2015-02023207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38020OtherLICENSE
NC2015-02023OtherNC LICENSE
VA1831169523Medicaid
TN3889600Medicaid
TN6682290001Medicare NSC
TN103I208619Medicare PIN