Provider Demographics
NPI:1093835100
Name:TIMOTHY DINEEN M.D.
Entity Type:Organization
Organization Name:TIMOTHY DINEEN M.D.
Other - Org Name:BLUERIDGE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DINEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-626-0484
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-0909
Mailing Address - Country:US
Mailing Address - Phone:859-626-0484
Mailing Address - Fax:859-626-3663
Practice Address - Street 1:103 ALYCIA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2368
Practice Address - Country:US
Practice Address - Phone:859-626-0484
Practice Address - Fax:859-626-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277981Medicaid
KY6679Medicare ID - Type Unspecified
KY64277981Medicaid