Provider Demographics
NPI:1093870180
Name:TIMOTHY HERRON MD INC
Entity Type:Organization
Organization Name:TIMOTHY HERRON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-626-6362
Mailing Address - Street 1:1200 PROSPECT STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3316
Mailing Address - Country:US
Mailing Address - Phone:419-626-6362
Mailing Address - Fax:
Practice Address - Street 1:1200 PROSPECT STREET SUITE 303
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3316
Practice Address - Country:US
Practice Address - Phone:419-626-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9246341Medicare ID - Type Unspecified