Basic Information
| Provider Information | |||||||||
| NPI: | 1689178899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOO | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4802 10TH AVE | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192916 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 BOW ST | ||||||||
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| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103984000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0091617 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.