Healthcare Provider Details

I. General information

NPI: 1073559985
Provider Name (Legal Business Name): TIMOTHY ALAN COAKLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

401 CAROLANNE POINT CIR
VIRGINIA BEACH VA
23462-4156
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3027
  • Fax:
Mailing address:
  • Phone: 757-508-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number85552
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2020-0012
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01046265A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101058840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: