Provider Demographics
NPI:1154302610
Name:FLYNN, TIMOTHY CORCORAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CORCORAN
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WELLESLEY TRADE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5576
Mailing Address - Country:US
Mailing Address - Phone:919-363-7546
Mailing Address - Fax:919-363-3616
Practice Address - Street 1:200 WELLESLEY TRADE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5576
Practice Address - Country:US
Practice Address - Phone:919-363-7546
Practice Address - Fax:919-363-3616
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29569207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22635OtherDOCTORS HEALTH PLAN
2549406OtherAETNA HMO
4230459OtherAETNA PPO
42294OtherPARTNERS
NC89128G2Medicaid
NC3108348002OtherCIGNA HEALTHCARE HMO
NC562070218FOtherCIGNA HEALTHCARE
0357057OtherUNITED HEALTHCARE
NC128G2OtherBCBS
290914OtherMAMSI/ALLIANCE
A6811OtherMEDCOST
4230459OtherAETNA PPO
2549406OtherAETNA HMO
NC3108348002OtherCIGNA HEALTHCARE HMO