Provider Demographics
NPI:1093893570
Name:LEDEAN, TIMOTHY A (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:LEDEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8082
Mailing Address - Country:US
Mailing Address - Phone:860-679-4992
Mailing Address - Fax:860-679-3334
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8082
Practice Address - Country:US
Practice Address - Phone:860-679-4992
Practice Address - Fax:860-679-3334
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A84632083X0100X
CT0773452083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08234Medicare UPIN
020A84630Medicare ID - Type Unspecified