Provider Demographics
NPI:1134284169
Name:TIMMINS, CAROL K (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:K
Last Name:TIMMINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MASS GENERAL PHYSICIANS ORGANIZATION INC
Mailing Address - Street 2:PO BOX 9142
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS GENERAL MEDICAL GROUP
Practice Address - Street 2:50 STANFORD STREET SUITE 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2946OtherBS
MA0349721Medicaid
MANP2946Medicare ID - Type Unspecified
MANP2946OtherBS