Provider Demographics
NPI:1992756050
Name:BERRIGAN, TIMOTHY JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:BERRIGAN
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 1:3053 W STATE ST
Mailing Address - Street 2:BLUE RIDGE RADIOLOGY, P.C.
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1720
Mailing Address - Country:US
Mailing Address - Phone:423-968-2711
Mailing Address - Fax:423-968-3453
Practice Address - Street 1:3053 W STATE ST
Practice Address - Street 2:BLUE RIDGE RADIOLOGY, P.C.
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1720
Practice Address - Country:US
Practice Address - Phone:423-968-2711
Practice Address - Fax:423-968-3453
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239952085R0202X
TN443452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT80301Medicaid
H81890Medicare UPIN
H818901550Medicare ID - Type Unspecified