Provider Demographics
NPI:1629062666
Name:PIKE, TIMOTHY S (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:PIKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVE STE 445
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1914
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5279
Practice Address - Street 1:825 FAIRFAX AVE STE 445
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1912
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5279
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30222325Medicaid
NHOX1092Medicare PIN
NH30222325Medicaid