Provider Demographics
NPI:1255437588
Name:WHITAKER, TIMOTHY SEAN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SEAN
Last Name:WHITAKER
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 100707
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0707
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:
Practice Address - Street 1:449 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2028
Practice Address - Country:US
Practice Address - Phone:607-432-5680
Practice Address - Fax:607-432-5575
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161759208600000X
NY218885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03157782Medicaid
NYJ400081654Medicare PIN
I14992Medicare UPIN