MEDICARE: TIMOTHY R HESSERT MD

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	208000000X	Pediatrics Physician	ME133640	FL
2	208000000X	Pediatrics Physician	181721	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101323DL	OTHER	NY	PREFERRED CARE
2	050915000029	OTHER	NY	FIDELIS
3	00020892902	OTHER	NY	UNIVERA
4	P010181721	OTHER	NY	BLUE CHOICE
5	1292886	OTHER	NY	IHA
6	10511492	OTHER	NY	CAQH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104884410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R HESSERT MD

Provider Business Mailing Address
First Line	:	5001 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5303
Country	:	US
Telephone Number	:	813-984-8846
Fax Number	:	813-984-8827

Provider Business Practice Location Address
First Line	:	5001 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5303
Country	:	US
Telephone Number	:	813-984-8846
Fax Number	:	813-984-8827

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/26/2021

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Directions to “ TIMOTHY R HESSERT MD” Practice Location

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