Provider Demographics
NPI:1144757451
Name:HONTZ, TIMOTHY DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:HONTZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MORGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25813-7709
Mailing Address - Country:US
Mailing Address - Phone:304-255-1300
Mailing Address - Fax:
Practice Address - Street 1:703 RITTER DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-1300
Practice Address - Fax:304-255-5391
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant