Provider Demographics
NPI:1740373729
Name:SIMPSON, TIMOTHY CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CLARK
Last Name:SIMPSON
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 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-1800
Mailing Address - Fax:814-938-1885
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-1800
Practice Address - Fax:814-938-1885
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074428L207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207P00000XOtherTAXONOMY
PAMD074428LMedicaid
PA1387757OtherBLUE SHIELD
PASI1387757OtherREFERRING ID
PAH59187Medicare UPIN
PA057181GW9Medicare ID - Type Unspecified