Provider Demographics
NPI:1336424282
Name:BLEECKER, TIM
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:BLEECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 RUGBY AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3034
Mailing Address - Country:US
Mailing Address - Phone:301-657-1130
Mailing Address - Fax:301-657-1131
Practice Address - Street 1:4827 RUGBY AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3034
Practice Address - Country:US
Practice Address - Phone:301-657-1130
Practice Address - Fax:301-657-1131
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist