Provider Demographics
NPI:1093741597
Name:MCKINNEY, TIMOTHY B (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:MCKINNEY
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 1:151 FRIES MILL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-374-1377
Mailing Address - Fax:856-374-2177
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-1377
Practice Address - Fax:856-374-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO5195600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE78419Medicare UPIN