Provider Demographics
NPI:1376564955
Name:MANAHAN, TIMOTHY JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:MANAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4761
Mailing Address - Country:US
Mailing Address - Phone:207-856-7656
Mailing Address - Fax:207-856-7659
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4761
Practice Address - Country:US
Practice Address - Phone:207-856-7656
Practice Address - Fax:207-856-7659
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1601204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH44375Medicare UPIN