Provider Demographics
NPI:1285682567
Name:ANDERSON, TIMOTHY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DOUGLAS
Last Name:ANDERSON
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:LAHEY CLINIC
Mailing Address - Street 2:41 MALL RD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8450
Mailing Address - Fax:781-744-3440
Practice Address - Street 1:LAHEY CLINIC
Practice Address - Street 2:41 MALL RD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8450
Practice Address - Fax:781-744-3440
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208958207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110008165AMedicaid
MAA3442902Medicare PIN