Provider Demographics
NPI:1154307676
Name:O'HARE, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:O'HARE
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 1:1344 S APOLLO BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3183
Mailing Address - Country:US
Mailing Address - Phone:321-676-2353
Mailing Address - Fax:321-951-9267
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE 301
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-676-2353
Practice Address - Fax:321-951-9267
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84166207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15346OtherBLUE CROSS BLUE SHIELD
FL198914OtherWELLCARE
FL263645000Medicaid
FL2862947OtherAETNA
FL040017000OtherRAILROAD MEDICARE
FL1356109001OtherCIGNA
FL7795340OtherAETNA
FL15346ZMedicare PIN
FL7795340OtherAETNA