Provider Demographics
NPI:1043280076
Name:MESS, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:MESS
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:PO BOX 5608
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5608
Mailing Address - Country:US
Mailing Address - Phone:818-782-5450
Mailing Address - Fax:818-780-4271
Practice Address - Street 1:15243 VANOWEN ST
Practice Address - Street 2:SUITE 406
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3605
Practice Address - Country:US
Practice Address - Phone:818-782-5450
Practice Address - Fax:818-780-4271
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46553207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG46553OtherMEDICARE, PTAN
CAA50421Medicare UPIN