Provider Demographics
NPI:1568424026
Name:TASH, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:TASH
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 1:291 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:800-688-6663
Mailing Address - Fax:413-589-7554
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:800-688-6663
Practice Address - Fax:413-582-2949
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2038862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-2486823OtherNORTHEAST HEALTHCARE ALLI
MA000000023435OtherBMC
MA04-2486823OtherGREAT-WEST
MA04-2486823OtherNORTH AMERICAN PREFERRED
MA04-2486823OtherPHCS
MA243315OtherHARVARD PILGRIM
MAJ24661OtherBCBS MA
MA04-2486823OtherNORTHEAST HEALTH DIRECT
MA0191591Medicaid
MA04-2486823OtherCONSOLIDATED
MA04-2486823OtherPLAN VISTA
MA04-2486823OtherUNICARE/GIC
MA203886OtherTUFTS
MA2837628OtherAETNA
MA6148632OtherCIGNA
H59742Medicare UPIN
MA2837628OtherAETNA