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General NPI Number Information
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NPI Number | 1841375920
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL KEILY BOCO
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | -2 WRAMC SUITE 3H 6900 GEORGIA AVE. NW
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-6385
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Fax | 202-782-9080
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Provider Business Mailing Address
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Address Line | 7807 LELAND RD
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City | MANASSAS
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State | VA
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Zip | 20111-1944
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Country | US
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Telephone | 703-369-2044
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | C22227
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License Number State | MD
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