Provider Demographics
NPI:1043215288
Name:SLAVEN, TIMOTHY M (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:SLAVEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:BLDG 200, STE 211
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-677-7776
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE.
Practice Address - Street 2:BLDG 200, SUITE 211
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-677-7776
Practice Address - Fax:609-677-7509
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002060A207RC0000X
NJ25MB08865300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0254142Medicaid
IN200254350AMedicaid
INH06665Medicare UPIN
NJ195508Medicare PIN