Provider Demographics
NPI:1154300887
Name:GATENS, TIMOTHY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:GATENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1360 STRATFORD WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7400
Mailing Address - Country:US
Mailing Address - Phone:740-344-9667
Mailing Address - Fax:740-348-4951
Practice Address - Street 1:1865 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1350
Practice Address - Country:US
Practice Address - Phone:740-348-4953
Practice Address - Fax:740-348-4951
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.043700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0529806Medicaid
OHA80377Medicare UPIN
OH0529806Medicaid