Provider Demographics
NPI:1447571302
Name:BESSELL, TRAVIS W (PA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:BESSELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:724-741-0044
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:188 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3208
Practice Address - Country:US
Practice Address - Phone:724-657-3220
Practice Address - Fax:724-657-3223
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054362363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA054362OtherMEDICAL LICENSE