Healthcare Provider Details

I. General information

NPI: 1255451910
Provider Name (Legal Business Name): TRAVIS JASON HOLLMANN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVENUE MEMORIAL HOSPITAL/ DEPT. OF PATHOLOGY
NEW YORK NY
10065
US

IV. Provider business mailing address

430 E 63RD ST APT 10K
NEW YORK NY
10065-0045
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-8134
  • Fax:
Mailing address:
  • Phone: 832-647-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number225823
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: