Healthcare Provider Details

I. General information

NPI: 1720391196
Provider Name (Legal Business Name): TIMOTHY ALLEN HEPWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 LEWISBERRY RD
NEW CUMBERLAND PA
17070-2313
US

IV. Provider business mailing address

PO BOX 8585
HARRISBURG PA
17105-8585
US

V. Phone/Fax

Practice location:
  • Phone: 717-909-2373
  • Fax:
Mailing address:
  • Phone: 717-909-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number440654
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301045641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: