Provider Demographics
NPI:1447228978
Name:TIMKO, CARRIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:TIMKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3018
Practice Address - Country:US
Practice Address - Phone:570-748-1260
Practice Address - Fax:570-748-1261
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420479207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019516580003Medicaid
PA1491762OtherHIGHMARK BLUE SHIELD
PA2517559OtherUNITEDHEALTHCARE
PA816893OtherFIRST PRIORITY HEALTH
PA0019516580004Medicaid
PA002990OtherFIRST PRIORITY HEALTH
PA68257OtherGEISINGER HEALTH PLAN
PAH80791OtherHEALTHAMERICA
PA7306468OtherAETNA
PAP00021107Medicare PIN
PA0019516580004Medicaid
PA0019516580003Medicaid