Provider Demographics
NPI:1285847699
Name:KO, TIMOTHY YEE-TAK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:YEE-TAK
Last Name:KO
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 1:2374 VILLAGE COMMON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7201
Mailing Address - Country:US
Mailing Address - Phone:814-833-7246
Mailing Address - Fax:814-833-1147
Practice Address - Street 1:2374 VILLAGE COMMON DR STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-833-7246
Practice Address - Fax:814-833-1147
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462767208VP0014X
OH35.087753208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023171040002Medicaid
OH2769311Medicaid
003665938OtherHIGHMARK
OH2769311Medicaid