Provider Demographics
NPI:1093767444
Name:MCLAUGHLIN, TIMOTHY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:THOMAS
Last Name:MCLAUGHLIN
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 1:3850 TAMPA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3670
Mailing Address - Country:US
Mailing Address - Phone:727-784-6779
Mailing Address - Fax:727-781-8910
Practice Address - Street 1:3850 TAMPA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3670
Practice Address - Country:US
Practice Address - Phone:727-784-6779
Practice Address - Fax:727-781-8910
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040997174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45858900Medicaid
30565XMedicare ID - Type Unspecified
FL45858900Medicaid