MEDICARE: DR. TIMOTHY WAYNE BROTHERTON M,D,

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	207RH0003X	Hematology & Oncology Physician	0101046457	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013919398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY WAYNE BROTHERTON M,D,

Provider Business Mailing Address
First Line	:	125 EXECUTIVE DR
Second Line	:	STE J
City	:	DANVILLE
State	:	VA
Zip	:	24541-4155
Country	:	US
Telephone Number	:	434-793-0044
Fax Number	:	434-792-8864

Provider Business Practice Location Address
First Line	:	125 EXECUTIVE DR
Second Line	:	STE J
City	:	DANVILLE
State	:	VA
Zip	:	24541-4155
Country	:	US
Telephone Number	:	434-793-0044
Fax Number	:	434-792-8864

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/19/2010

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