Provider Demographics
NPI:1861681322
Name:TIMBER H GORMAN MD
Entity Type:Organization
Organization Name:TIMBER H GORMAN MD
Other - Org Name:DOWNEAST EYE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMBER
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-667-9690
Mailing Address - Street 1:390 BAR HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04605-5807
Mailing Address - Country:US
Mailing Address - Phone:207-667-9690
Mailing Address - Fax:207-667-6064
Practice Address - Street 1:390 BAR HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605-5807
Practice Address - Country:US
Practice Address - Phone:207-667-9690
Practice Address - Fax:207-667-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014431261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8636Medicare PIN