Provider Demographics
NPI:1093713281
Name:TRAVAGLINE, DENNIS R (CH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:TRAVAGLINE
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S MCCAIN DR
Mailing Address - Street 2:UNIT 8
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6093
Mailing Address - Country:US
Mailing Address - Phone:301-624-0024
Mailing Address - Fax:301-624-0026
Practice Address - Street 1:4 S MCCAIN DR
Practice Address - Street 2:UNIT 8
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6093
Practice Address - Country:US
Practice Address - Phone:301-624-0024
Practice Address - Fax:301-624-0026
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1584302OtherCAREFIRST BCBS
061718321OtherFIDELITY PMG
225097OtherKAISER-MID ATLANTIC
701713OtherNCPPO
061718321OtherHUMANA/CHOICE CARE
7923537OtherAETNA NON-HMO
4400799OtherAMERICHOICE
DCJ571-0001OtherCAREFIRST
061718321OtherCIGNA
061718321OtherUNITED HEALTHCARE
2127202OtherMAMSI
2127202OtherOPTIMUM CHOICE
MD001955100Medicaid
061718321OtherINFORMED
105576OtherJOHN HOPKINS
2127202OtherMDIPA
2127202OtherALLIANCE
3501294OtherAETNA HMO
2127202OtherOPTIMUM CHOICE
3501294OtherAETNA HMO