Provider Demographics
NPI:1932116654
Name:NEELY, TRAVIS R (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:R
Last Name:NEELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4240
Mailing Address - Fax:717-848-5520
Practice Address - Street 1:2050 S QUEEN ST
Practice Address - Street 2:STE 100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-4240
Practice Address - Fax:717-848-5520
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439573208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1883146OtherHIGHMARK BLUE SHIELD-WMG
000000486819OtherANTHEM BCBS
PA102440921Medicaid
PAP009073OtherGATEWAY-WMG
PA414478OtherUPMC-WMG
001883146OtherMOUNTAIN STATE BCBS
OH2548381Medicaid
PA30073061OtherAMERIHEALTH MERCY-WMG
WV3810005968Medicaid
PA303397OtherUNISON-WMG
PAP009073OtherGATEWAY-WMG
PA1883146OtherHIGHMARK BLUE SHIELD-WMG
WV4187803Medicare PIN
001883146OtherMOUNTAIN STATE BCBS