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General NPI Number Information
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NPI Number | 1093835100
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Entity Type | Organization
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Legal Business Name | TIMOTHY DINEEN M.D.
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 103 ALYCIA DR
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City | RICHMOND
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State | KY
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Zip | 40475-2368
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Country | US
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Telephone | 859-626-0484
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Fax | 859-626-3663
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | BEREA
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State | KY
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Zip | 40403-0909
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Country | US
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Telephone | 859-626-0484
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Fax | 859-626-3663
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | DR. TIMOTHY E DINEEN
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Credential | M.D.
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Telephone | 859-626-0484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 27798
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License Number State | KY
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