Healthcare Provider Details

I. General information

NPI: 1306808860
Provider Name (Legal Business Name): TRAVIS MARTIN POLK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-2111
US

IV. Provider business mailing address

3032 JACOBS GARDEN LN
FREDERICK MD
21701-3384
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4440
  • Fax:
Mailing address:
  • Phone: 757-375-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD438425
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number438425
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101233378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: