MEDICARE: DR. LORI ANN TRAVERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	200201014	NC

General Provider Information

NPI Number	:	1447475595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI ANN TRAVERS M.D.

Provider Business Mailing Address
First Line	:	4600 KEIGHLEY PL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-3463
Country	:	US
Telephone Number	:	919-673-2128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 ATRIUM DR
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6452
Country	:	US
Telephone Number	:	919-673-2128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/16/2008

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