Healthcare Provider Details

I. General information

NPI: 1861493306
Provider Name (Legal Business Name): TIMOTHY HENRY KNIERIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MEDICAL PARK SUITE 401
WHEELING WV
26003-6392
US

IV. Provider business mailing address

40 MEDICAL PARK SUITE 401
WHEELING WV
26003-6392
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-3880
  • Fax: 304-243-3895
Mailing address:
  • Phone: 304-243-3880
  • Fax: 304-243-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21477
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: