Healthcare Provider Details

I. General information

NPI: 1255437588
Provider Name (Legal Business Name): TIMOTHY SEAN WHITAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 MAIN ST
ONEONTA NY
13820-2028
US

IV. Provider business mailing address

PO BOX 100707
ATLANTA GA
30384-0707
US

V. Phone/Fax

Practice location:
  • Phone: 607-432-5680
  • Fax: 607-432-5575
Mailing address:
  • Phone: 786-594-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME161759
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number218885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: