Healthcare Provider Details

I. General information

NPI: 1730359316
Provider Name (Legal Business Name): ELEANOR MAY TRAVERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8828 GERMANTOWN AVE
PHILADELPHIA PA
19118-2719
US

IV. Provider business mailing address

8828 GERMANTOWN AVE
PHILADELPHIA PA
19118-2719
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-1490
  • Fax:
Mailing address:
  • Phone: 215-247-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberMD029866L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD029866L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD029866L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: