Provider Demographics
NPI:1972577997
Name:HORMEL, TIMOTHY L (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:HORMEL
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 1:1942 BRAEBURN CIR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7388
Mailing Address - Country:US
Mailing Address - Phone:540-725-3500
Mailing Address - Fax:540-725-4449
Practice Address - Street 1:1942 BRAEBURN CIR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7388
Practice Address - Country:US
Practice Address - Phone:540-725-3500
Practice Address - Fax:540-725-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010341842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA130023623OtherRAILROAD MEDICARE
VA005857139Medicaid
VA130000783Medicare ID - Type Unspecified
VA005857139Medicaid