Provider Demographics
NPI:1154321974
Name:MONAHAN, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MONAHAN
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 1:55 GREEN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3533
Mailing Address - Country:US
Mailing Address - Phone:860-779-1865
Mailing Address - Fax:860-779-3820
Practice Address - Street 1:55 GREEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3533
Practice Address - Country:US
Practice Address - Phone:860-779-1865
Practice Address - Fax:860-779-3820
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56318207N00000X
CT047373207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology