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General NPI Number Information
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NPI Number | 1912202193
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Entity Type | Individual
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Provider Name | JOHN TRAVERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 2055 CATHILL RD
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City | TELFORD
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State | PA
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Zip | 18969-1068
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Country | US
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Telephone | 215-262-2733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 181
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City | TELFORD
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State | PA
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Zip | 18969-0181
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Country | US
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Telephone | 215-262-2733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA05083000
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License Number State | NJ
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