Provider Demographics
NPI:1326091471
Name:TREADWAY, TRAVIS W (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:W
Last Name:TREADWAY
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 1:1358 LUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9302
Mailing Address - Country:US
Mailing Address - Phone:717-249-8300
Mailing Address - Fax:717-249-8301
Practice Address - Street 1:1358 LUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9302
Practice Address - Country:US
Practice Address - Phone:717-249-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077352Medicare ID - Type UnspecifiedMEDICARE
PAH01428Medicare UPIN