Provider Demographics
NPI:1982908067
Name:COLGROVE, TIMOTHY CHRISTOPHER (COF)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHRISTOPHER
Last Name:COLGROVE
Suffix:
Gender:M
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9010
Mailing Address - Country:US
Mailing Address - Phone:828-651-4992
Mailing Address - Fax:828-651-4993
Practice Address - Street 1:1 PJS PL
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7204
Practice Address - Country:US
Practice Address - Phone:828-651-4992
Practice Address - Fax:828-651-4993
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCFO03553OtherCOF