Provider Demographics
NPI:1306969480
Name:DEEULIS, TIMOTHY GUINEY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GUINEY
Last Name:DEEULIS
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 1:2828 1ST AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-529-1005
Mailing Address - Fax:304-529-1006
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-529-1005
Practice Address - Fax:304-529-1006
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15951207VH0002X, 207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0709282Medicaid
WV0091663000Medicaid
OH0709282Medicaid
WVWV63010281Medicare PIN