Provider Demographics
NPI:1558479261
Name:OLSON, TIMOTHY H (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:OLSON
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 1:35 WELLS ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2962
Mailing Address - Country:US
Mailing Address - Phone:401-348-3865
Mailing Address - Fax:
Practice Address - Street 1:25 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2922
Practice Address - Country:US
Practice Address - Phone:401-348-3865
Practice Address - Fax:401-348-3641
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51390208VP0014X
RIMD14068208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT51390OtherCT LICENSE
RIMD14068OtherRI LICENSE