MEDICARE: DR. TIMOTHY JOSEPH O'LEARY MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	D0025865	MD
2	207ZP0101X	Anatomic Pathology Physician	D0025865	MD
3	208D00000X	General Practice Physician	D25865	MD
4	207ZP0101X	Anatomic Pathology Physician	D25865	MD

General Provider Information

NPI Number	:	1003899873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JOSEPH O'LEARY MD, PHD

Provider Business Mailing Address
First Line	:	4755 CAMP ROOSEVELT DRIVE
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732
Country	:	US
Telephone Number	:	240-460-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 CAMP ROOSEVELT DRIVE
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732
Country	:	US
Telephone Number	:	240-460-0271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2005
Last Update Date	:	08/05/2019

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