Healthcare Provider Details

I. General information

NPI: 1700223815
Provider Name (Legal Business Name): TRAVIS BLOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CROSSINGS BLVD
WARWICK RI
02886-2878
US

IV. Provider business mailing address

83 DON AVE
RUMFORD RI
02916-2304
US

V. Phone/Fax

Practice location:
  • Phone: 401-777-7000
  • Fax:
Mailing address:
  • Phone: 978-877-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number278087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD16243
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD16243
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: