Healthcare Provider Details

I. General information

NPI: 1679618045
Provider Name (Legal Business Name): TIMOTHY BIDDLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SAVAGE RD
FORT GEORGE G MEADE MD
20755-5999
US

IV. Provider business mailing address

1737 TARRYTOWN AVE
CROFTON MD
21114-2538
US

V. Phone/Fax

Practice location:
  • Phone: 301-688-7264
  • Fax:
Mailing address:
  • Phone: 410-721-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberH0053556
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: