Provider Demographics
NPI:1841375920
Name:KEILY, TIMOTHY PAUL (BOCO)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:KEILY
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 LELAND RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-1944
Mailing Address - Country:US
Mailing Address - Phone:703-369-2044
Mailing Address - Fax:
Practice Address - Street 1:-2 WRAMC SUITE 3H
Practice Address - Street 2:6900 GEORGIA AVE. NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6385
Practice Address - Fax:202-782-9080
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC22227247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other