Provider Demographics
NPI:1164929386
Name:TIMOTHY M NARDINE MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TIMOTHY M NARDINE MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-396-3480
Mailing Address - Street 1:2530 BERRYESSA RD STE 218
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2903
Mailing Address - Country:US
Mailing Address - Phone:408-356-4959
Mailing Address - Fax:408-358-8692
Practice Address - Street 1:2530 BERRYESSA RD STE 218
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2903
Practice Address - Country:US
Practice Address - Phone:408-356-4959
Practice Address - Fax:408-358-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty