Provider Demographics
NPI:1043314198
Name:KELLIHER, TIMOTHY RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:KELLIHER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CONANT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1659
Mailing Address - Country:US
Mailing Address - Phone:978-922-2226
Mailing Address - Fax:978-922-2269
Practice Address - Street 1:83 HERRICK ST STE 1001
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2753
Practice Address - Country:US
Practice Address - Phone:978-922-2226
Practice Address - Fax:978-922-2269
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA756132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
J31266OtherBLUE CROSS
814325OtherAETNA USHC
DM9771OtherHCHP
722666OtherTUFTS
MAA20168Medicaid
MAA20168Medicaid
A20168Medicare ID - Type Unspecified