Provider Demographics
NPI:1356342976
Name:PIRNAT, TIMOTHY J (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:PIRNAT
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 347
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-0347
Mailing Address - Country:US
Mailing Address - Phone:937-218-6635
Mailing Address - Fax:888-422-2159
Practice Address - Street 1:12980 SABINA RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9578
Practice Address - Country:US
Practice Address - Phone:937-218-6635
Practice Address - Fax:888-422-2159
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IN01074988A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201289650Medicaid
OH0781104Medicaid
IN000000941674OtherANTHEM PROVIDER NUMBER
OH0666594Medicare PIN
OH250007242Medicare PIN
OH0781104Medicaid
IN815500094Medicare PIN