Provider Demographics
NPI:1164757258
Name:KO, TIMOTHY ALLEN (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:KO
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1466
Mailing Address - Fax:315-470-8060
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-701-2550
Practice Address - Fax:315-701-2551
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2021-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY013607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant