Healthcare Provider Details

I. General information

NPI: 1235579657
Provider Name (Legal Business Name): TRAVIS KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

7122 MOORLAND DR
CLARKSVILLE MD
21029-1735
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3080
  • Fax:
Mailing address:
  • Phone: 954-562-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberD0080225
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: