Provider Demographics
NPI:1942293014
Name:KINKEAD, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:KINKEAD
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 1:130 NORTH ST
Mailing Address - Street 2:STE A
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-775-8282
Mailing Address - Fax:508-775-1414
Practice Address - Street 1:130 NORTH STREET
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-775-8282
Practice Address - Fax:508-775-1414
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210782207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200045931OtherRAILROAD MEDICARE
MA0190560Medicaid
3227468OtherAETNA
210782OtherTUFTS
J24109OtherBCBS
172723OtherPILGRIM
8377149002OtherCIGNA
0901063OtherUNITED HEALTH
0901063OtherUNITED HEALTH
3227468OtherAETNA
8377149002OtherCIGNA