Provider Demographics
NPI:1720026503
Name:SCARBROUGH, TIMOTHY L (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:SCARBROUGH
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 1:5151 REED RD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-457-2306
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED RD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-457-2306
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049166S207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599642Medicaid
OH050021873OtherMEDICARE RAILROAD
OHSC0572183Medicare ID - Type Unspecified
OH050021873OtherMEDICARE RAILROAD