Healthcare Provider Details

I. General information

NPI: 1154302610
Provider Name (Legal Business Name): TIMOTHY CORCORAN FLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WELLESLEY TRADE LN
CARY NC
27519-5576
US

IV. Provider business mailing address

200 WELLESLEY TRADE LN
CARY NC
27519-5576
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-7546
  • Fax: 919-363-3616
Mailing address:
  • Phone: 919-363-7546
  • Fax: 919-363-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number29569
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number29569
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: