1801866835 NPI number — TIMOTHY B. SHORT M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801866835 NPI number — TIMOTHY B. SHORT M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHORT

Provider First Name:

TIMOTHY

Provider Middle Name:

B.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1801866835

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/12/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 9007

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHARLOTTESVILLE

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22906-9007

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

LEE ST FL 3

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHARLOTTESVILLE

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22908-0001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

434-243-6361

Provider Business Practice Location Address Fax Number:

434-243-6280

Provider Enumeration Date:

01/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  0101040226 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QH0002X , with the licence number: 0101040226 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QH0002X , with the licence number: 036-126666 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0002X , with the licence number: 0101040226 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 080141641 . This is a "MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 234064 . This is a "ANTHEM SVC/HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 267138 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 700010935 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 45187 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 142901 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: P00212563 . This is a "MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 005638623 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 45187 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".