Provider Demographics
NPI:1467452177
Name:WARD, TIMOTHY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:ROLAND E. MILLER FAMILY PRACTICE
Mailing Address - Street 2:104 EAST SECOND STREET
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507
Mailing Address - Country:US
Mailing Address - Phone:814-877-6131
Mailing Address - Fax:814-877-2322
Practice Address - Street 1:ROLAND E. MILLER FAMILY PRACTICE
Practice Address - Street 2:104 EAST SECOND STREET
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-877-6131
Practice Address - Fax:814-877-2322
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039695L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1058373Medicaid
C33453Medicare UPIN
PA1058373Medicaid