Healthcare Provider Details

I. General information

NPI: 1922160787
Provider Name (Legal Business Name): ADIN L TIMBAYAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 WASHINGTON ST
MONTGOMERY WV
25136
US

IV. Provider business mailing address

PO BOX 299 411 WASHINGTON ST
MONTGOMERY WV
25136
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-4204
  • Fax: 304-442-4204
Mailing address:
  • Phone: 304-442-4204
  • Fax: 304-442-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA S TIMBAYAN
Title or Position: SECRETARY
Credential: MD
Phone: 304-442-4204