Healthcare Provider Details

I. General information

NPI: 1235628025
Provider Name (Legal Business Name): TIMOTHY PATRICK MCCANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 E TOWN ST
COLUMBUS OH
43215-4602
US

IV. Provider business mailing address

10500 MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-5400
  • Fax: 614-788-5500
Mailing address:
  • Phone: 513-865-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.146271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: