Provider Demographics
NPI:1184686875
Name:NOVINGER, TRAVIS ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ANDREW
Last Name:NOVINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-2404
Mailing Address - Country:US
Mailing Address - Phone:843-921-4851
Mailing Address - Fax:843-921-4854
Practice Address - Street 1:316 2ND ST
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-2404
Practice Address - Country:US
Practice Address - Phone:843-921-4851
Practice Address - Fax:843-921-4854
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
200315212OtherTAX IDENTIFICATION NUMBER
200315212OtherTAX IDENTIFICATION NUMBER