Basic Information
Provider Information | |||||||||
NPI: | 1144213760 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SEMPOWSKI | ||||||||
FirstName: | TIMOTHY | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 785 5TH AVENUE | ||||||||
Address2: | SUITE 3 | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172014232 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172639555 | ||||||||
FaxNumber: | 7172174217 | ||||||||
Practice Location | |||||||||
Address1: | 112 N 7TH ST | ||||||||
Address2: |   | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172011720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172677164 | ||||||||
FaxNumber: | 7172677414 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2005 | ||||||||
LastUpdateDate: | 10/28/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | OS007856L | PA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | OS007856L | PA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 1541263 | 01 | PA | GATEWAY (AFC) | OTHER | 1818940 | 01 | PA | AETNA HMO (AFC) | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 6802736 | 01 | PA | AETNA HMO (PMFC) | OTHER | OS007856L | 01 | PA | LICENSE | OTHER | 227938 | 01 | PA | UNISON (AFC) | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 001536159 0003 | 05 | PA |   | MEDICAID | 781457 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | P00458425 | 01 | PA | RAILROAD MEDICARE | OTHER | 1007307260037 | 01 | PA | MEDICAID GROUP # (PMFC) | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 50073141 | 01 | PA | CAPITAL BLUECROSS (AFC) | OTHER | 50083159 | 01 | PA | CAPITAL BLUECROSS (PMFC) | OTHER | G920-0105 | 01 | PA | CAREFIRST | OTHER | 2105895 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | PHCS/MULTIPLAN | OTHER | 289731 | 01 | PA | UNISON (PMFC) | OTHER | 050514 | 01 | PA | MEDICARE GROUP # | OTHER | 1007307260036 | 01 | PA | MEDICAID GROUP # (AFC) | OTHER | 120420418 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 5038050 | 01 | PA | AETNA NON-HMO | OTHER | BS3290145 | 01 | PA | DEA | OTHER | PEARL PROVIDER | 01 | PA | HEALTH AMERICA | OTHER |