Provider Demographics
NPI:1144228131
Name:TIMSON, KATRINA M (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:TIMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6516
Mailing Address - Country:US
Mailing Address - Phone:220-564-1846
Mailing Address - Fax:220-564-1847
Practice Address - Street 1:399 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6516
Practice Address - Country:US
Practice Address - Phone:220-564-1846
Practice Address - Fax:220-564-1847
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829241Medicaid
OH0829241Medicaid