Doctor Name: | CAROL TRAVERS |
NPI Number: | 1992728653 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.A. |
License Number: | MA002471L |
Business Practice Address: | 11 Ingot Dr Blandon, PA - 195109639 |
Business Phone Number: | 6109448818 |
Business Fax Number: | |
Mailing Address: | 11 Ingot Dr, BLANDON |
State: | PA |
Postal Code: | 195109639 |
Phone Number: | 6109448818 |
Fax Number: | |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 08/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA002471L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |