MEDICARE: TIMOTHY M NARDINE MD MEDICAL CORPORATION

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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1164929386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY M NARDINE MD MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2530 BERRYESSA RD STE 218
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2903
Country	:	US
Telephone Number	:	408-356-4959
Fax Number	:	408-358-8692

Provider Business Practice Location Address
First Line	:	2530 BERRYESSA RD STE 218
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2903
Country	:	US
Telephone Number	:	408-356-4959
Fax Number	:	408-358-8692

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	TIMOTHY NARDINE
Credential	:	MD
Telephone Number	:	346-396-3480

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	03/08/2024

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