Provider Demographics
NPI:1861451098
Name:TIMPERMAN, V. DIANA (MD)
Entity Type:Individual
Prefix:
First Name:V. DIANA
Middle Name:
Last Name:TIMPERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:419-529-6285
Mailing Address - Fax:419-529-3150
Practice Address - Street 1:2003 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1787
Practice Address - Country:US
Practice Address - Phone:419-529-6285
Practice Address - Fax:419-529-3150
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2024713Medicaid
OH0743824Medicaid
OH2255312Medicaid
OHE82885Medicare UPIN