Provider Demographics
NPI:1073292793
Name:DOWD, TIMOTHY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DOWD
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MAPLE HTS
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1016
Mailing Address - Country:US
Mailing Address - Phone:607-776-3301
Mailing Address - Fax:
Practice Address - Street 1:216 MAPLE HTS
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1016
Practice Address - Country:US
Practice Address - Phone:607-776-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401369-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice