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General NPI Number Information
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NPI Number | 1699709139
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Entity Type | Individual
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Provider Name | TIMOTHY J KINSELLA MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 3175 HARBOR BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6729
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Country | US
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Telephone | 941-627-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 DEERWOOD CT
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-8763
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Country | US
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Telephone | 216-544-5218
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 35-073919
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 159050
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 39665
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD13152
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License Number State | RI
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