Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101233378 | VA |
Y | 208600000X | Surgeon | 0101233378 | VA |
N | 2086S0102X | Surgical Critical Care | MD438425 | PA |
NPI | 1306808860 |
---|---|
Provider Name | Dr. Travis Martin Polk |
First Address | Portsmouth, VA 23708-2111 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 17/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10122737 | OPTIMA HEALTH (01) | VA |
1306808860 | (05) | NC |
1306808860 | (05) | VA |
1306808860 | COVENTRY NETWORK (01) | VA |
1306808860 | UNITED HEALTHCARE (01) | VA |
1306808860 | VIRGINIA PREMIER HEALTH PLAN (01) | VA |
505895 | ANTHEM BC/BS (01) | VA |
PAR | AETNA (01) | VA |
PAR | CIGNA (01) | VA |
PAR | CORVEL (01) | VA |
PAR | MULTIPLAN (01) | VA |
PAR | USA MANAGED CARE (01) | VA |
PAR | VIRGINIA HEALTH NETWORK (01) | VA |