Healthcare Provider Details

I. General information

NPI: 1225033772
Provider Name (Legal Business Name): TIMOTHY JAMES DENNEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MALL BLVD
BLOOMSBURG PA
17815-8389
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-416-5435
  • Fax: 570-416-5436
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD035289E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: