Provider Demographics
NPI:1447299573
Name:TREVETT, MILLICENT H (MD)
Entity type:Individual
Prefix:DR
First Name:MILLICENT
Middle Name:H
Last Name:TREVETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:716-876-5512
Mailing Address - Fax:716-876-7342
Practice Address - Street 1:4041 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-876-5512
Practice Address - Fax:716-876-7342
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207530207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000526444001OtherBLUE CROSS BLUE SHIELD
0086173OtherGHI
00025601301OtherUNIVERA
NY02273210Medicaid
160056905OtherRAILROAD BLOCK 24K
0711192OtherIHA
156782CKOtherPREFERRED CARE
156782CKOtherPREFERRED CARE
0086173OtherGHI
0711192OtherIHA