Provider Demographics
NPI:1962498592
Name:QUILL, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:QUILL
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - DEPT OF CRITICAL CARE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-4642
Mailing Address - Fax:603-650-0614
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC - DEPT OF CRITICAL CARE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-4642
Practice Address - Fax:603-650-0614
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009762207L00000X
NH8360207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0001268Medicaid
NH80001268Medicaid
VT0001268Medicaid
NHVN320902Medicare PIN
NH80001268Medicaid