Provider Demographics
NPI:1972525574
Name:TIMMERMAN, MARK LEO (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LEO
Last Name:TIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:454 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3695
Mailing Address - Country:US
Mailing Address - Phone:603-424-8120
Mailing Address - Fax:603-424-8140
Practice Address - Street 1:454 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3699
Practice Address - Country:US
Practice Address - Phone:603-424-8120
Practice Address - Fax:603-424-8140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NHNH 7663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA140824540OtherBC/BS MASS BILLING #
NH30D0084963OtherCLIA NUMBER
NH0103422YPNH01OtherBC/BS INDIVIDUAL NUMBER
NHNH 7663OtherNH STATE LICENSE
NHB86207OtherHPHC BILLING NUMBER
NH50Y095600NH01OtherBC/BS NH GROUP NUMBER
NH50Y095600NH01OtherBC/BS NH GROUP NUMBER
NHNH 7663OtherNH STATE LICENSE
MA140824540OtherBC/BS MASS BILLING #
NHNH 7663OtherNH STATE LICENSE