Basic Information
| Provider Information | |||||||||
| NPI: | 1730129578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMRON | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 VALLEY DRIVE | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046754340 | ||||||||
| FaxNumber: | 3046756911 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 VALLEY DRIVE | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046751484 | ||||||||
| FaxNumber: | 3046751496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 15124 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 35.083882 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000675429 | 01 | KY | ANTHEM BCBS | OTHER | P00803885 | 01 | OH | RAILROAD MEDICARE | OTHER | 0779439 | 01 | OH | OH MEDICAID MOLINA | OTHER | 0779439 | 05 | OH | MEDICAID | 64071400 | 05 | KY | MEDICAID | 000000290591 | 01 | OH | OH MEDICAID UNISON | OTHER | 0073423000 | 05 | WV | MEDICAID | 310917085220 | 01 | OH | OH MEDICAID CARESOURCE | OTHER |