Provider Demographics
NPI:1538503909
Name:STRADFORD, TRAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:STRADFORD
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 1:214 DUFFIELD ST APT 53M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7051
Mailing Address - Country:US
Mailing Address - Phone:301-512-7076
Mailing Address - Fax:
Practice Address - Street 1:100 HAVEN AVE
Practice Address - Street 2:APARTMENT 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2645
Practice Address - Country:US
Practice Address - Phone:301-512-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2775392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty