Provider Demographics
NPI:1760760474
Name:LEUPP, TIMOTHY CONNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CONNOR
Last Name:LEUPP
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 1:1650 WEWATTA ST APT 2021
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6280
Mailing Address - Country:US
Mailing Address - Phone:917-554-8052
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62389207R00000X
NY269905-1207R00000X
WAMD.61472437207R00000X
IAMD-42960207R00000X
MI4301112613207R00000X
WI407-320207R00000X
SD13065207R00000X
COCDR.0001479207R00000X
UT13159316-1205207R00000X
ME20249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine