Provider Demographics
NPI:1568411973
Name:EHRLICH, TIMOTHY B II (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:EHRLICH
Suffix:II
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 1:12 SHERWOOD FARMS LANE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-226-5667
Mailing Address - Fax:203-557-4898
Practice Address - Street 1:115 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE C100
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-899-0744
Practice Address - Fax:203-268-6779
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0400945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60058Medicare UPIN
CT020001543Medicare ID - Type Unspecified