Provider Demographics
NPI:1609808146
Name:TIMOTHY, NIGEL H (MD)
Entity Type:Individual
Prefix:
First Name:NIGEL
Middle Name:H
Last Name:TIMOTHY
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 1:95 WASHINGTON STREET
Mailing Address - Street 2:SUITE 592, VILLAGE SHOPPES
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021
Mailing Address - Country:US
Mailing Address - Phone:781-989-4744
Mailing Address - Fax:781-769-4794
Practice Address - Street 1:95 WASHINGTON STREET
Practice Address - Street 2:SUITE 592, VILLAGE SHOPPES
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-989-4744
Practice Address - Fax:781-769-4794
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2122855Medicaid
MAI45342Medicare UPIN
MAA39378Medicare PIN