Healthcare Provider Details

I. General information

NPI: 1770557175
Provider Name (Legal Business Name): TIMOTHY DENNIS KANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE. N.W., W4-200
WASHINGTON DC
20010
US

IV. Provider business mailing address

111 MICHIGAN AVE. N.W., W4-200
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2151
  • Fax: 202-476-4174
Mailing address:
  • Phone: 202-476-2151
  • Fax: 202-476-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD073515L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD038997
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: