Provider Demographics
NPI:1356504534
Name:TIMKO, MORIAH LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:LYNN
Last Name:TIMKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MORIAH
Other - Middle Name:LYNN
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636388
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST UNIT 2B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-5157
Practice Address - Fax:419-251-5160
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3147848Medicaid
OHH006801Medicare PIN