Provider Demographics
NPI:1073562088
Name:GREENAN, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:GREENAN
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 1:14915 BROSCHART ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-251-7897
Mailing Address - Fax:
Practice Address - Street 1:14915 BROSCHART ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-251-7897
Practice Address - Fax:301-251-7898
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044122E174400000X
MDD0041613174400000X, 2085R0202X
NY205142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD307841800Medicaid
NY300086644OtherMEDICARE RAILROAD
NY01853516Medicaid
NY300119922OtherMEDICARE RAILROAD
PA0015522500006Medicaid
PA0015522500006Medicaid
NY300119922OtherMEDICARE RAILROAD
NY01853516Medicaid
PA048472TSNMedicare PIN
MD020006P18Medicare PIN
NY631591Medicare PIN