Provider Demographics
NPI:1023050788
Name:DEBIASSE, TIMOTHY ALBERT (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALBERT
Last Name:DEBIASSE
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 1:3950 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1870
Mailing Address - Country:US
Mailing Address - Phone:724-325-2133
Mailing Address - Fax:724-733-2278
Practice Address - Street 1:3950 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1870
Practice Address - Country:US
Practice Address - Phone:724-325-2133
Practice Address - Fax:724-733-2278
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B40267Medicare UPIN