Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101040226 | VA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0101040226 | VA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036-126666 | IL |
Y | 207RH0002X | Hospice and Palliative Medicine | 0101040226 | VA |
NPI | 1801866835 |
---|---|
Provider Name | Timothy B. Short |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 12/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005638623 | (05) | VA |
080141641 | MEDICARE PIN (01) | VA |
142901 | SOUTHERN HEALTH (01) | VA |
234064 | ANTHEM SVC/HEALTHKEEPERS (01) | VA |
267138 | MAMSI (01) | VA |
45187 | (05) | VA |
45187 | COMMUNITY HEALTH (01) | VA |
700010935 | CIGNA (01) | VA |
B60235 | (02) | |
P00212563 | MEDICARE PIN (01) | VA |