Healthcare Provider Details

I. General information

NPI: 1851493951
Provider Name (Legal Business Name): BRUCE IRA TIMINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 NEWMARKET SQ
NEWPORT NEWS VA
23605-2721
US

IV. Provider business mailing address

48 NEWMARKET SQ
NEWPORT NEWS VA
23605-2721
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-8030
  • Fax: 757-847-9149
Mailing address:
  • Phone: 757-825-8030
  • Fax: 757-847-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101263854
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME36915
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2010-0552
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: