Provider Demographics
NPI:1366197378
Name:ANDREW, TIMOTHY L SR
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:ANDREW
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MULBERRY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8922
Mailing Address - Country:US
Mailing Address - Phone:513-344-7858
Mailing Address - Fax:
Practice Address - Street 1:73 MULBERRY ST APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8922
Practice Address - Country:US
Practice Address - Phone:513-344-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066593Medicaid