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NPI Code Detail

MEDICARE: DR. TIMOTHY B MCCONNELL M.D.

MEDICARE: DR. TIMOTHY B MCCONNELL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician35-080-0340MOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00068010OTHEROHMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063426351
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY B MCCONNELL M.D.
Provider Business Mailing Address
First Line : 6480 HARRISON AVE STE 201
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7961
Country : US
Telephone Number : 513-354-3700
Fax Number : 513-354-3705
Provider Business Practice Location Address
First Line : 8099 CORNELL RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45249-2231
Country : US
Telephone Number : 513-357-3700
Fax Number : 513-354-3705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2006
Last Update Date : 07/13/2020

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