1093713281 NPI number — DENNIS R TRAVAGLINE CH

Table of content: DENNIS R TRAVAGLINE CH (NPI 1093713281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093713281 NPI number — DENNIS R TRAVAGLINE CH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVAGLINE
Provider First Name:
DENNIS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093713281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 S MCCAIN DR
Provider Second Line Business Mailing Address:
UNIT 8
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21703-6093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-624-0024
Provider Business Mailing Address Fax Number:
301-624-0026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 S MCCAIN DR
Provider Second Line Business Practice Location Address:
UNIT 8
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21703-6093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-624-0024
Provider Business Practice Location Address Fax Number:
301-624-0026
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  S02048 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1584302 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 061718321 . This is a "FIDELITY PMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 225097 . This is a "KAISER-MID ATLANTIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701713 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061718321 . This is a "HUMANA/CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7923537 . This is a "AETNA NON-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400799 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J571-0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 061718321 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061718321 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2127202 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2127202 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001955100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061718321 . This is a "INFORMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 105576 . This is a "JOHN HOPKINS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2127202 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2127202 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3501294 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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