Provider Demographics
NPI:1376602276
Name:WEBB, TIMOTHY STANWOOD (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STANWOOD
Last Name:WEBB
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 1:211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6117
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6117
Practice Address - Country:US
Practice Address - Phone:207-872-6869
Practice Address - Fax:207-872-7910
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD111009207Q00000X
WAMD00033993207Q00000X
ME018802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1376602276Medicaid
ME1376602276Medicaid
WAG34467Medicare UPIN