Trident Medical Group PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRIDENT MEDICAL GROUP PA

Practice address

10440 Little Patuxent Pkwy Ste 300
Columbia, MD 21044-3648

Phone

(855) 770-7771

Fax

(415) 808-6405

NPI assigned

Feb 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Devion Smith

Title

Director, Payer Contracting

Phone

(424) 326-8711

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1083368831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 NE 191ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331793899",
            "telephone_number": "310-626-0149",
            "fax_number": "415-808-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10440 LITTLE PATUXENT PKWY STE 300",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443648",
            "telephone_number": "855-770-7771",
            "fax_number": "415-808-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEVION",
        "authorized_official_title_or_position": "DIRECTOR, PAYER CONTRACTING",
        "authorized_official_telephone_number": "424-326-8711"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213EP0504X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquisha Traylor
• Spencer Henry Tredo, PT
• Sara Trescott, LCPC, NCC
• Jean Ann Tretler, R.N., IBCLC
• Carla Trevizo, PTA
• Anh Trinh
• Trinity Familycare and Express Healthcare LLC
• Kaylee Joyce Triplett
• Jeleesa Triplin, BEHAVIOR TECH
• Triumph Healthcare & Support Services LLC

• Internal Medicine Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.