Provider Demographics
NPI:1376705616
Name:KERMODE, TIMOTHY TULLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TULLEY
Last Name:KERMODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-594-8819
Practice Address - Fax:740-594-4099
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.010689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH130850Medicare UPIN