Healthcare Provider Details

I. General information

NPI: 1801862693
Provider Name (Legal Business Name): TIMOTHY PAUL PENDLETON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SUMMIT STREET
BROOKVILLE PA
15825
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-8329
  • Fax: 814-849-5441
Mailing address:
  • Phone: 814-849-8329
  • Fax: 814-849-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA53094
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD428157
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD428157
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: