Healthcare Provider Details

I. General information

NPI: 1194985606
Provider Name (Legal Business Name): TRAVIS ROSWELL HOBART MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 RTE 31 BELGIUM MEADOWS
BALDWINSVILLE NY
13027-9231
US

IV. Provider business mailing address

3448 RTE 31 BELGIUM MEADOWS
BALDWINSVILLE NY
13027-9231
US

V. Phone/Fax

Practice location:
  • Phone: 315-622-6595
  • Fax: 315-622-3298
Mailing address:
  • Phone: 315-622-6595
  • Fax: 315-622-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number270683
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number270683
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD037582
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: