Provider Demographics
NPI:1730129578
Name:DAMRON, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:DAMRON
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 1:2520 VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550
Mailing Address - Country:US
Mailing Address - Phone:304-675-4340
Mailing Address - Fax:304-675-6911
Practice Address - Street 1:2520 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-675-1484
Practice Address - Fax:304-675-1496
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15124207RC0000X
OH35.083882207RC0000X
KY43849207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000675429OtherANTHEM BCBS
OHP00803885OtherRAILROAD MEDICARE
OH0779439OtherOH MEDICAID MOLINA
OH0779439Medicaid
KY64071400Medicaid
OH000000290591OtherOH MEDICAID UNISON
WV0073423000Medicaid
OH310917085220OtherOH MEDICAID CARESOURCE
OHPTAN 0707914Medicare PIN
F13405Medicare UPIN
WV0073423000Medicaid
WV0707913Medicare PIN
OH9273461Medicare PIN