Provider Demographics
NPI:1407060387
Name:HIGGINS, TIMOTHY (RD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19133 CHERRY TREE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2826
Mailing Address - Country:US
Mailing Address - Phone:301-714-4041
Mailing Address - Fax:301-714-4351
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 108
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6734
Practice Address - Country:US
Practice Address - Phone:301-714-4041
Practice Address - Fax:301-714-4351
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02116133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic