Provider Demographics
NPI:1578532388
Name:TRAVERS, ROBIN LIBERTY (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LIBERTY
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-1600
Mailing Address - Fax:617-731-1601
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-1600
Practice Address - Fax:617-731-1601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
154067OtherTUFTS
MAJ17541OtherBLUE SHIELD
401166OtherHARVARD PILGRIM
0010506OtherNHP
0300049OtherUNITED
2694770OtherAETNA
6692063001OtherCIGNA
0010506OtherNHP
6692063001OtherCIGNA