Provider Demographics
NPI:1164481784
Name:COLLARD, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:COLLARD
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 1:3925 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-0000
Mailing Address - Country:US
Mailing Address - Phone:716-250-9999
Mailing Address - Fax:716-250-4177
Practice Address - Street 1:3925 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-0000
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-4177
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110322-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8843Medicare PIN
NYCC8843Medicare ID - Type Unspecified
NYB71074Medicare UPIN