Provider Demographics
NPI:1861493306
Name:KNIERIM, TIMOTHY HENRY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HENRY
Last Name:KNIERIM
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 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-243-3880
Mailing Address - Fax:304-243-3895
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 401
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-243-3880
Practice Address - Fax:304-243-3895
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2487232Medicaid
WV55035705700OtherWV COMPENSATION
WV3810000145Medicaid
21477OtherHEALTH PLAN OF UPPER OH V
OH2487232Medicaid
WV55035705700OtherWV COMPENSATION
WV7320931Medicare PIN