Provider Demographics
NPI:1326557372
Name:COBB, TIMOTHY A (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:COBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:354 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04681-3217
Mailing Address - Country:US
Mailing Address - Phone:207-367-2311
Mailing Address - Fax:207-367-2805
Practice Address - Street 1:354 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681-3217
Practice Address - Country:US
Practice Address - Phone:207-367-2311
Practice Address - Fax:207-367-2805
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1326557372Medicaid