Provider Demographics
NPI:1124070149
Name:TIMBAYAN, ADIN LIM (MD)
Entity type:Individual
Prefix:DR
First Name:ADIN
Middle Name:LIM
Last Name:TIMBAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WASHINGTON ST
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136
Mailing Address - Country:US
Mailing Address - Phone:304-442-4204
Mailing Address - Fax:304-442-4204
Practice Address - Street 1:411 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136
Practice Address - Country:US
Practice Address - Phone:304-442-4204
Practice Address - Fax:304-442-4204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0128102000Medicaid
D49275Medicare UPIN
TI0444861Medicare ID - Type Unspecified