Provider Demographics
NPI:1376549584
Name:EDDY, TIMOTHY J (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:EDDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2927
Mailing Address - Country:US
Mailing Address - Phone:978-630-5030
Mailing Address - Fax:
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2927
Practice Address - Country:US
Practice Address - Phone:978-630-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
221868OtherUGS
MA1320815Medicaid
MAM18970OtherBLUE SHIELD OF MA
MAM18970OtherBLUE SHIELD OF MA
MA1320815Medicaid
221868OtherUGS