Provider Demographics
NPI:1962569657
Name:HARLAN, TIMOTHY SHANNON (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SHANNON
Last Name:HARLAN
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 1:1177 22ND ST NW UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1253
Mailing Address - Country:US
Mailing Address - Phone:504-931-2929
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVENUE, NW
Practice Address - Street 2:DEPT. OF MEDICINE - DIVI.OF GENERAL INTERNAL MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-741-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 201361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5837294Medicaid
VAF60454Medicare UPIN
VA5837294Medicaid