Provider Demographics
NPI:1043201452
Name:CANTY, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:CANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MADISON AVE RM 702
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6713
Mailing Address - Country:US
Mailing Address - Phone:917-524-7246
Mailing Address - Fax:718-509-6961
Practice Address - Street 1:149 MADISON AVE RM 702
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6713
Practice Address - Country:US
Practice Address - Phone:917-524-7246
Practice Address - Fax:718-509-6961
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215688207L00000X, 207LP2900X
NY237504207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28261OtherBCBS MA
MA2090031Medicaid
MA466528OtherTUFTS HEALTH PLAN
MAJ28261OtherBCBS MA
MA2090031Medicaid