Healthcare Provider Details

I. General information

NPI: 1144757451
Provider Name (Legal Business Name): TIMOTHY DAVID HONTZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RITTER DRIVE
BEAVER WV
25813
US

IV. Provider business mailing address

703 RITTER DR
GLEN MORGAN WV
25813-7709
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-1300
  • Fax: 304-255-5391
Mailing address:
  • Phone: 304-255-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: