Provider Demographics
NPI:1710960646
Name:MCLAUGHLIN, TIMOTHY PATRICK
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEWELL RD
Mailing Address - Street 2:SUITE C14
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5100
Mailing Address - Country:US
Mailing Address - Phone:860-589-3766
Mailing Address - Fax:860-583-8934
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:SUITE C14
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-589-3766
Practice Address - Fax:860-583-8934
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02808Medicare UPIN