MEDICARE: TIMOTHY MICHAEL LANDIS 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	2084N0400X	Neurology Physician	0101279273	VA

General Provider Information

NPI Number	:	1881258168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MICHAEL LANDIS MD

Provider Business Mailing Address
First Line	:	PO BOX 639969
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 BREMO RD STE 207
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1922
Country	:	US
Telephone Number	:	804-893-8656
Fax Number	:	804-287-7018

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

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	10/12/2023

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