Basic Information
| Provider Information | |||||||||
| NPI: | 1912906611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINCHESTER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 NICHOLASVILLE RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775771 | ||||||||
| FaxNumber: | 8592764622 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 NICHOLASVILLE RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775771 | ||||||||
| FaxNumber: | 8592764622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 24034 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64240344 | 05 | KY | MEDICAID |