Provider Demographics
NPI:1831195791
Name:WEST, TIMOTHY EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:WEST
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 1:1938 B CHARLIE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414
Mailing Address - Country:US
Mailing Address - Phone:843-402-0227
Mailing Address - Fax:843-402-0232
Practice Address - Street 1:1938 B CHARLIE HALL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-402-0227
Practice Address - Fax:843-402-0232
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7429207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1016Medicaid
SCD17945Medicare UPIN
SC4744Medicare PIN