Provider Demographics
NPI:1700370137
Name:MATTINGLY, TRAVIS MOAKLEY (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MOAKLEY
Last Name:MATTINGLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 467
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3434
Mailing Address - Country:US
Mailing Address - Phone:610-896-0210
Mailing Address - Fax:610-896-5101
Practice Address - Street 1:100 E LANCASTER AVE STE 467
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3434
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:610-896-5101
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS022855207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease