MEDICARE: TIMOTHY PATRICK CLOHERTY MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G843840	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356409379	OTHER	CA	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G843840	OTHER	CA	MEDICAL BOARD OF CA
4	ZZZ42967Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1790843712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY PATRICK CLOHERTY MD

Provider Business Mailing Address
First Line	:	5652 CALLE REAL
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-2317
Country	:	US
Telephone Number	:	805-967-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	5652 CALLE REAL
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-2317
Country	:	US
Telephone Number	:	805-967-1539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/05/2014

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Directions to “ TIMOTHY PATRICK CLOHERTY MD” Practice Location

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