Provider Demographics
NPI:1821214230
Name:TIMOTHY J. KROSS, M, D,., P.A.
Entity Type:Organization
Organization Name:TIMOTHY J. KROSS, M, D,., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROSS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:412-262-5860
Mailing Address - Street 1:935 THORN RUN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-262-5860
Mailing Address - Fax:412-269-3432
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-262-5860
Practice Address - Fax:412-269-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030698E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB42003Medicare UPIN
PA121073Medicare PIN