Provider Demographics
NPI:1316992530
Name:DINEEN, TIMOTHY E (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:E
Last Name:DINEEN
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 1:103 ALYCIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2368
Mailing Address - Country:US
Mailing Address - Phone:859-626-1504
Mailing Address - Fax:859-626-3663
Practice Address - Street 1:101 ALYCIA DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-626-1504
Practice Address - Fax:859-626-3663
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277981Medicaid
KY64277981Medicaid
KY6679Medicare ID - Type Unspecified