Provider Demographics
NPI:1508890658
Name:WEDDINGTON, TRAVIS CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:CRAIG
Last Name:WEDDINGTON
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 1:110 IRVING ST
Mailing Address - Street 2:G220A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-877-7783
Mailing Address - Fax:301-929-0348
Practice Address - Street 1:110 IRVING ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-7783
Practice Address - Fax:301-929-0348
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21872207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD121990100Medicaid
DC200107OtherKAISER
DC5336451OtherAETNA NON HMO
DC0071OtherCAREFIRST BCBS
DC022155300Medicaid
DC501358OtherNCPPO
VA5706670Medicaid
DC441114OtherANTHEM BCBS
DC2495271OtherAETNA HMO
DC200107OtherKAISER
DC2495271OtherAETNA HMO
F93883Medicare UPIN