Provider Demographics
NPI:1194985606
Name:HOBART, TRAVIS ROSWELL (MD, MPH)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ROSWELL
Last Name:HOBART
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 RTE 31
Mailing Address - Street 2:BELGIUM MEADOWS
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9231
Mailing Address - Country:US
Mailing Address - Phone:315-622-6595
Mailing Address - Fax:315-622-3298
Practice Address - Street 1:3448 RTE 31
Practice Address - Street 2:BELGIUM MEADOWS
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9231
Practice Address - Country:US
Practice Address - Phone:315-622-6595
Practice Address - Fax:315-622-3298
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY270683208000000X, 2083P0901X
DCMD037582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03645681Medicaid
NY03645681Medicaid