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General NPI Number Information
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NPI Number | 1477057768
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Entity Type | Individual
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Provider Name | TIMOTHY KOKANOVICH MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 51 IVY RIDGE LN
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2339
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Country | US
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Telephone | 540-245-7262
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Fax | 540-245-7054
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Provider Business Mailing Address
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Address Line | PO BOX 388
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City | FISHERSVILLE
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State | VA
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Zip | 22939-0388
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Country | US
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Telephone | 540-245-7262
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Fax | 540-932-5875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 64460
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 401
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License Number State | CA
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