Provider Demographics
NPI:1477534063
Name:TRAVERS, CHARLES KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KENNETH
Last Name:TRAVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DR
Mailing Address - Street 2:STE 320
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:301-681-3400
Mailing Address - Fax:301-681-7982
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:STE 320
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-681-3400
Practice Address - Fax:301-681-7982
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0017830207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD311071100Medicaid
MD000F60C21Medicare PIN
MD311071100Medicaid