Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 0101051871 | VA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101051871 | VA |
NPI | 1164422507 |
---|---|
Provider Name | Dr. Timothy A Queen |
First Address | Newport News, VA 23606 |
Second Address | Newport News, VA 23606-4437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/03/2021 |