Provider Demographics
NPI:1003899873
Name:O'LEARY, TIMOTHY JOSEPH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 CAMP ROOSEVELT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732
Mailing Address - Country:US
Mailing Address - Phone:240-460-0271
Mailing Address - Fax:
Practice Address - Street 1:4755 CAMP ROOSEVELT DRIVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732
Practice Address - Country:US
Practice Address - Phone:240-460-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025865207ZP0007X, 207ZP0101X
MDD25865208D00000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice