Healthcare Provider Details

I. General information

NPI: 1700992948
Provider Name (Legal Business Name): JOHN VINCENT TIMKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RIDGEWOOD RD SUITE 400
WYOMISSING PA
19610-1189
US

IV. Provider business mailing address

2201 RIDGEWOOD RD SUITE 400
WYOMISSING PA
19610-1189
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-9601
  • Fax:
Mailing address:
  • Phone: 610-378-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberMD050742-L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD050742L
License Number StatePA
# 9
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD050742L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: