Provider Demographics
NPI:1801876263
Name:SORRELLS, TIMOTHY CLIFFTON (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLIFFTON
Last Name:SORRELLS
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:NAVAL HOSPITAL 100 BREWSTER BLVD
Mailing Address - Street 2:LABORATORY DEPARTMENT
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547
Mailing Address - Country:US
Mailing Address - Phone:910-459-3366
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL 100 BREWSTER BLVD
Practice Address - Street 2:LABORATORY DEPARTMENT
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14825207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology