Doctor Name: | MARTHA E TYMESON |
NPI Number: | 1730126814 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 236941 |
Business Practice Address: | 76 Veterans Ave Behavioral Health Room 511 Bath, NY - 148100810 |
Business Phone Number: | 6076644300 |
Business Fax Number: | 6076644320 |
Mailing Address: | 76 Veterans Ave, Behavioral Health Room 511 BATH |
State: | NY |
Postal Code: | 148100810 |
Phone Number: | 6076644300 |
Fax Number: | 6076644320 |
NPI Enumeration Date: | 05/31/2006 |
NPI Last Update Date: | 05/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | 236941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |