Healthcare Provider Details

I. General information

NPI: 1992637417
Provider Name (Legal Business Name): TIMOTHY RICHARD DOTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BOND ST
HAMPTON VA
23666-2045
US

IV. Provider business mailing address

319 BOND ST
HAMPTON VA
23666-2045
US

V. Phone/Fax

Practice location:
  • Phone: 740-418-3772
  • Fax:
Mailing address:
  • Phone: 740-418-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: