Provider Demographics
NPI:1285787341
Name:ELLISON, TREVOR ASHTON (MD, PHD, MBA)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:ASHTON
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MCNAUGHTEN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5111
Mailing Address - Country:US
Mailing Address - Phone:614-627-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS STREET
Practice Address - Street 2:SUITE 7107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-4618
Practice Address - Country:US
Practice Address - Phone:410-955-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT4123208600000X
OH35.134693208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery