MEDICARE: DR. DIANE TRAVER MD

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	207Q00000X	Family Medicine Physician	152741	NY

General Provider Information

NPI Number	:	1962466300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE TRAVER MD

Provider Business Mailing Address
First Line	:	85 W BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-4015
Country	:	US
Telephone Number	:	718-716-4400
Fax Number	:	718-228-7471

Provider Business Practice Location Address
First Line	:	625 E 137TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-3142
Country	:	US
Telephone Number	:	718-401-6578
Fax Number	:	718-228-7471

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. DIANE TRAVER MD” Practice Location

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