Provider Demographics
NPI:1811955487
Name:JAMESON, TIMOTHY L (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:JAMESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 ALLENTOWN PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510
Mailing Address - Country:US
Mailing Address - Phone:610-926-3669
Mailing Address - Fax:
Practice Address - Street 1:8500 ALLENTOWN PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9460
Practice Address - Country:US
Practice Address - Phone:610-926-3669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005597L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
JA068797Medicare ID - Type Unspecified
E19475Medicare UPIN