Provider Demographics
NPI:1861469876
Name:CLARE, TIMOTHY PETER (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PETER
Last Name:CLARE
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:40 WHITE OAK
Practice Address - Street 2:PROFESSIONAL CENTER
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5638
Practice Address - Country:US
Practice Address - Phone:740-678-2374
Practice Address - Fax:740-678-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-1719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0591417Medicaid
OH000000699780OtherANTHEM
WV0053963000Medicaid
OH000000678715OtherANTHEM
0566838Medicare ID - Type Unspecified
4057801Medicare ID - Type Unspecified
OH000000699780OtherANTHEM
OH0591417Medicaid
WV0053963000Medicaid
OH4057802Medicare PIN