Provider Demographics
NPI:1184860454
Name:MCLAIN, TIM (LMT)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3913
Mailing Address - Country:US
Mailing Address - Phone:207-699-7558
Mailing Address - Fax:
Practice Address - Street 1:17 SALEM ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3913
Practice Address - Country:US
Practice Address - Phone:207-699-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist