Provider Demographics
NPI:1841239233
Name:GAJEWSKI, TIMOTHY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:GAJEWSKI
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 1:3600 SEA MOUNTAIN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8161
Mailing Address - Country:US
Mailing Address - Phone:843-347-8600
Mailing Address - Fax:843-347-8702
Practice Address - Street 1:3600 SEA MOUNTAIN HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8161
Practice Address - Country:US
Practice Address - Phone:843-399-9696
Practice Address - Fax:843-399-9596
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL37911208800000X
WY10957A208800000X
NC39425208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340016946OtherINDIVIDUAL RAILROAD MCR #
SC4129749OtherAETNA
FLP01487390OtherRAILROAD MEDICARE
NC7934311Medicaid
NC1841239233Medicaid
NC34311OtherINDIVIDUAL BC/BS NC #
SCN39425Medicaid
SC1099192OtherUNITED HEALTHCARE
SC1111886OtherWELLCARE
SC2607136OtherCIGNA
NC7934311Medicaid
NC2154167KMedicare PIN
SC4129749OtherAETNA
SC2607136OtherCIGNA
FLP01487390OtherRAILROAD MEDICARE
SCN39425Medicaid