Provider Demographics
NPI:1598116469
Name:GRAVELY, TREVOR S (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:S
Last Name:GRAVELY
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 1:200 HERLONG AVE S STE G
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1182
Mailing Address - Country:US
Mailing Address - Phone:803-909-6300
Mailing Address - Fax:
Practice Address - Street 1:200 HERLONG AVE S STE G
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-909-6300
Practice Address - Fax:803-909-6310
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1519502086S0102X, 174400000X, 208600000X, 2086S0127X
SC900832086S0127X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery