Healthcare Provider Details

I. General information

NPI: 1477534063
Provider Name (Legal Business Name): CHARLES KENNETH TRAVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOCKWOOD DR STE 320
SILVER SPRING MD
20901-1556
US

IV. Provider business mailing address

10801 LOCKWOOD DR STE 320
SILVER SPRING MD
20901-1556
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-3400
  • Fax: 301-681-7982
Mailing address:
  • Phone: 301-681-3400
  • Fax: 301-681-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberD0017830
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: