Healthcare Provider Details

I. General information

NPI: 1518519602
Provider Name (Legal Business Name): TIMOTHY SHANNON WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 PUBLIC LANDING RD
SNOW HILL MD
21863-2453
US

IV. Provider business mailing address

6040 PUBLIC LANDING RD
SNOW HILL MD
21863-2453
US

V. Phone/Fax

Practice location:
  • Phone: 410-632-1100
  • Fax: 410-632-2476
Mailing address:
  • Phone: 410-632-1100
  • Fax: 410-632-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR209523
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: