Healthcare Provider Details

I. General information

NPI: 1336204502
Provider Name (Legal Business Name): TIMOTHY M SITTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD SUITE 3206
BURKE VA
22015-2880
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7212
  • Fax: 703-249-7250
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD45744
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101036793
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD21389
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: