Provider Demographics
NPI:1982449997
Name:TRAVIS, CORINNE ALEXANDRA ROMERO (PA-C)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:ALEXANDRA ROMERO
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5417 LUCKPENNY PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2331
Mailing Address - Country:US
Mailing Address - Phone:443-472-8375
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0009440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant