Healthcare Provider Details

I. General information

NPI: 1811961154
Provider Name (Legal Business Name): TIMOTHY JOSEPH YORK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W RIVERSIDE ST
COVINGTON VA
24426-1273
US

IV. Provider business mailing address

411 W RIVERSIDE ST
COVINGTON VA
24426-1273
US

V. Phone/Fax

Practice location:
  • Phone: 540-960-2111
  • Fax: 540-960-2117
Mailing address:
  • Phone: 540-960-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1878
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102203160
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: