Provider Demographics
NPI:1093785867
Name:TIMPERMAN, WALTER W JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:W
Last Name:TIMPERMAN
Suffix:JR
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:PO BOX 631104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1104
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:610 W MAIN ST
Practice Address - Street 2:CLINTON CO. MEMORIAL HOSPITAL PATH DEPT
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2125
Practice Address - Country:US
Practice Address - Phone:937-382-9262
Practice Address - Fax:937-283-9706
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068095T207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0148414Medicaid
OH7020071Medicare PIN
TI7020072Medicare PIN