Provider Demographics
NPI:1700992948
Name:TIMKO, JOHN VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:TIMKO
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 1:2201 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1189
Mailing Address - Country:US
Mailing Address - Phone:610-378-9601
Mailing Address - Fax:
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050742L174400000X, 2084P0800X
261QM2500X, 273R00000X, 282N00000X, 310400000X, 3104A0625X, 314000000X
PAMD050742-L283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA632265XTGMedicare PIN
PAGO0298Medicare UPIN
PA632265Medicare PIN