Provider Demographics
NPI:1811961154
Name:YORK, TIMOTHY JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:YORK
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 1:411 W RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1273
Mailing Address - Country:US
Mailing Address - Phone:540-960-2111
Mailing Address - Fax:
Practice Address - Street 1:411 W RIVERSIDE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1273
Practice Address - Country:US
Practice Address - Phone:540-960-2111
Practice Address - Fax:540-960-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1878208000000X
VA0102203160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811961154OtherANTHEM BCBS
VA1811961154Medicaid
WV3810002348Medicaid
WV1811961154OtherHIGHMARK BCBS
WV3810002348Medicaid