Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | D25865 | MD |
NPI | 1003899873 |
---|---|
Provider Name | Dr. Timothy Joseph O'leary |
First Address | Chesapeake Beach, MD 20732 |
Second Address | Chesapeake Beach, MD 20732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2005 |
Last Update Date | 05/08/2019 |