Provider Demographics
NPI:1780290866
Name:TRAVERSA, GENEVIEVE AURORA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:AURORA
Last Name:TRAVERSA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARKLEY LN APT 172
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-6351
Mailing Address - Country:US
Mailing Address - Phone:240-688-9306
Mailing Address - Fax:
Practice Address - Street 1:1734 MARYLAND AVE # 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5804
Practice Address - Country:US
Practice Address - Phone:240-688-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered