Provider Demographics
NPI:1831284116
Name:THISTLETHWAITE, TIMOTHY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:THISTLETHWAITE
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 1:100 PEYTON WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8767
Mailing Address - Country:US
Mailing Address - Phone:304-205-5207
Mailing Address - Fax:304-205-5318
Practice Address - Street 1:100 PEYTON WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8767
Practice Address - Country:US
Practice Address - Phone:304-205-5207
Practice Address - Fax:304-205-5318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV174982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry