Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101046066 | VA |
Y | 207YP0228X | Pediatric Otolaryngology | 0101046066 | VA |
NPI | 1225094667 |
---|---|
Provider Name | Dr. Timothy Paul Mcbride |
First Address | Fairfax, VA 22031-5207 |
Second Address | Fairfax, VA 22031-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006535518 | (05) | VA |
C30815 | (02) | VA |