Healthcare Provider Details

I. General information

NPI: 1730129578
Provider Name (Legal Business Name): TIMOTHY A DAMRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DRIVE
POINT PLEASANT WV
25550
US

IV. Provider business mailing address

2520 VALLEY DRIVE
POINT PLEASANT WV
25550
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-1484
  • Fax: 304-675-1496
Mailing address:
  • Phone: 304-675-4340
  • Fax: 304-675-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15124
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.083882
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: