Provider Demographics
NPI:1780803833
Name:TRAVIS, KENNETH W (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:TRAVIS
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 1:595 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1117
Mailing Address - Country:US
Mailing Address - Phone:603-650-2908
Mailing Address - Fax:
Practice Address - Street 1:DARMOUTH HITCHOCK MED CT
Practice Address - Street 2:ONE MEDICAL CTRE DRIVE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-650-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30480207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology