Provider Demographics
NPI:1528039476
Name:KROSS, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:KROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2593 WEXFORD BAYNE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8608
Mailing Address - Country:US
Mailing Address - Phone:724-759-7273
Mailing Address - Fax:724-759-7315
Practice Address - Street 1:2593 WEXFORD BAYNE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8608
Practice Address - Country:US
Practice Address - Phone:724-759-7273
Practice Address - Fax:724-759-7315
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030698E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1041993Medicaid
PA1041993Medicaid
B42003Medicare UPIN