Provider Demographics
NPI:1912995184
Name:O'BRIEN, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:O'BRIEN
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 1:27 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6221
Mailing Address - Country:US
Mailing Address - Phone:716-483-2020
Mailing Address - Fax:716-488-9295
Practice Address - Street 1:27 PORTER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6221
Practice Address - Country:US
Practice Address - Phone:716-483-2020
Practice Address - Fax:716-488-9295
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195904207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001304520Medicaid
NY01507753Medicaid
PA0399350001Medicare NSC
PA001304520Medicaid
NY0399350003Medicare NSC
NY50932EMedicare PIN
PA138326E41Medicare PIN