Provider Demographics
NPI:1043446503
Name:HARTSHORN, TIMOTHY AUGUST (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:AUGUST
Last Name:HARTSHORN
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 1:2351 OCEAN VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755
Mailing Address - Country:US
Mailing Address - Phone:310-546-3461
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST STE C
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:781-429-7700
Practice Address - Fax:781-429-7701
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107628207X00000X
MA250238207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO187AMedicare PIN