Provider Demographics
NPI:1114917390
Name:MCKNIGHT, TIMOTHY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:MCKNIGHT
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 1:819 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1003
Mailing Address - Country:US
Mailing Address - Phone:740-922-0000
Mailing Address - Fax:
Practice Address - Street 1:819 N. FIRST STREET
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621
Practice Address - Country:US
Practice Address - Phone:740-922-0000
Practice Address - Fax:740-922-7408
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119871Medicaid
OH2119871Medicaid
OHG95770Medicare UPIN