Timothy Medianick, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS036510 Issued in PA

Practice address

430 Kenhorst Blvd
Reading, PA 19611-1830

Phone

(610) 775-0321

Fax

(610) 777-8884

NPI assigned

May 11, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1750596045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 BORDEAUX DR",
            "city": "MOHNTON",
            "state": "PA",
            "postal_code": "195408905",
            "telephone_number": "717-823-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 KENHORST BLVD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196111830",
            "telephone_number": "610-775-0321",
            "fax_number": "610-777-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIANICK",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS036510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Thomas McRae
• Jessica McWreath, MS, OTR/L
• George R Meade
• Valerie Mecham, BSW
• Medexpress Urgent Care, PC - Pennsylvania
• Megan V Carrier, Rd, LLC
• Saania Mehrin, DMD
• Suzanne Claudette Meidinger
• Tarynn Ashleigh Meier
• Monica J Mejia, MS

• Dentist in Reading, PA
• Providers in Reading, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.