Provider Demographics
NPI:1851644637
Name:VOLLMER, TIMOTHY WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WALTER
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TIMBERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-4150
Mailing Address - Country:US
Mailing Address - Phone:814-593-1215
Mailing Address - Fax:814-253-5843
Practice Address - Street 1:10 TIMBERVIEW LN
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-4150
Practice Address - Country:US
Practice Address - Phone:814-593-1215
Practice Address - Fax:814-253-5843
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018568207L00000X, 207LP2900X, 208VP0014X
FLAD9470826-528604207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992069173OtherNPI TYPE 2 ENTITY (UF SHANDS)