Provider Demographics
NPI:1902874050
Name:MAREAN, TIMOTHY ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ARTHUR
Last Name:MAREAN
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 1:6965 HILL STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-5420
Mailing Address - Country:US
Mailing Address - Phone:719-393-2327
Mailing Address - Fax:
Practice Address - Street 1:BARKELEY AVE BUILDING 1041
Practice Address - Street 2:DIRAIMONDO FAMILY CLINIC
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-524-2048
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics