Individual
TIMOTHY B MCKERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1906 BELLEVIEW AVE SE, EMERGENCY DEPT., ROANOKE, VA 24014-1838
(540) 981-7000
(540) 981-9550
Mailing address
PO BOX 2080, KILMARNOCK, VA 22482-2080
(804) 435-3508
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101222078
VA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0101222078
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010043603
—
VA
05
—
010043913
—
VA
Enumeration date
03/29/2006
Last updated
10/26/2021
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