Most Relevant Information
Provider Data
| NPI Number: | 1003200601 |
| Provider Name: | TREVOR G JACKSON M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/23/2015 |
| Last Updated: | 10/02/2024 |
Provider Practice Location
231 GRANITE RUN DRIVE
LANCASTER
PA
176016823
Practice Location Phone/Fax
| Phone: | 7175604200 |
| Fax: | 7175604200 |
Provider Mailing Location
231 GRANITE RUN DRIVE
LANCASTER
PA
176016823
Provider Mailing Phone/Fax
| Phone: | 7175604200 |
| Fax: | 7175604200 |