Provider Demographics
NPI:1013934538
Name:GERMAIN, TIMOTHY JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:GERMAIN
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 1:2315 MYRTLE ST STE 290B
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4609
Mailing Address - Country:US
Mailing Address - Phone:814-452-7300
Mailing Address - Fax:814-452-5015
Practice Address - Street 1:2315 MYRTLE ST STE 290B
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4609
Practice Address - Country:US
Practice Address - Phone:814-452-7300
Practice Address - Fax:814-452-5015
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010196841208200000X
PAMD463261208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010196841Medicaid
VA009317P01Medicare ID - Type Unspecified
VA010196841Medicaid