Provider Demographics
NPI:1275551764
Name:CODD, TIMOTHY P (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:CODD
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 1:8322 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-337-5321
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2012
Practice Address - Country:US
Practice Address - Phone:410-337-7900
Practice Address - Fax:410-337-5321
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040212207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149491100Medicaid
S783G812Medicare ID - Type Unspecified
MD149491100Medicaid