Provider Demographics
NPI:1225381973
Name:KAUFMAN, TRAVIS EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:EDWARD
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 SUTCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5578
Mailing Address - Country:US
Mailing Address - Phone:757-746-4100
Mailing Address - Fax:
Practice Address - Street 1:1600 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20500-0003
Practice Address - Country:US
Practice Address - Phone:202-814-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1108143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN