Timothy Andrew Wienke

Key facts

NPI

1003358573

Entity type

Individual (NPI type 1)

Primary specialty

Independent Duty Corpsman 1710I1002X

Practice address

3399 Strauss Ave
Indian Head, MD 20640-5164

Phone

(301) 744-2038

NPI assigned

Nov 15, 2016

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 15, 2016.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1003358573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3934 SCANLAND RD",
            "city": "INDIAN HEAD",
            "state": "MD",
            "postal_code": "206404425",
            "telephone_number": "661-317-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3399 STRAUSS AVE",
            "city": "INDIAN HEAD",
            "state": "MD",
            "postal_code": "206405164",
            "telephone_number": "301-744-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIENKE",
        "first_name": "TIMOTHY",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Head, MD

• The Heard Group, LLC
• Dean Tobin
• Keisha Monice Vilsaint, PNP
• Michael A Walls, IDC
• Danielle Whitacre, PA-C
• Lauraann Williams-Nketia
• Dexter Arvange Woods, D.D.S

All providers in Indian Head, MD · Independent Duty Corpsman in Maryland