Provider Demographics
NPI:1841294485
Name:KUMP, TIMOTHY M (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:KUMP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-0376
Mailing Address - Country:US
Mailing Address - Phone:570-265-7700
Mailing Address - Fax:570-268-4266
Practice Address - Street 1:1786 GOLDEN MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9733
Practice Address - Country:US
Practice Address - Phone:570-265-7700
Practice Address - Fax:570-268-4266
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003249L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001964262Medicaid
PA001964262Medicaid