Provider Demographics
NPI:1760572234
Name:TOBIN, TIMOTHY JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:TOBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 109U
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-927-1911
Mailing Address - Fax:978-927-1811
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 109U
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-927-1911
Practice Address - Fax:978-927-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1930213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0357928Medicaid
MAY70922Medicare ID - Type UnspecifiedMC#
MA0357928Medicaid