Provider Demographics
NPI:1629067749
Name:MARONEY, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MARONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1418
Mailing Address - Country:US
Mailing Address - Phone:610-519-0125
Mailing Address - Fax:610-519-0126
Practice Address - Street 1:1200 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GLADWYNE
Practice Address - State:PA
Practice Address - Zip Code:19035-1418
Practice Address - Country:US
Practice Address - Phone:610-519-0125
Practice Address - Fax:610-519-0126
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4259012085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
090140Medicare ID - Type Unspecified
A52202Medicare UPIN