Provider Demographics
NPI:1588158109
Name:MAZER, TRENT (MD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:MAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 E MARKET ST STE 64B
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5197
Mailing Address - Country:US
Mailing Address - Phone:540-564-5666
Mailing Address - Fax:
Practice Address - Street 1:1790 E MARKET ST STE 64B
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5197
Practice Address - Country:US
Practice Address - Phone:540-564-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114569207Q00000X
MI4351034175207Q00000X
VA0101272901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine