Healthcare Provider Details

I. General information

NPI: 1144220732
Provider Name (Legal Business Name): MORGAN TIMOTHY HOLMES D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E MAIN ST SUITE 3
NORTH EAST PA
16428-1319
US

IV. Provider business mailing address

90 E MAIN ST SUITE 3
NORTH EAST PA
16428-1319
US

V. Phone/Fax

Practice location:
  • Phone: 814-725-2715
  • Fax: 814-725-5186
Mailing address:
  • Phone: 814-725-2715
  • Fax: 814-725-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003377L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: