Provider Demographics
NPI:1336180314
Name:THIMINEUR, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:THIMINEUR
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 DIVISION ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-732-1570
Mailing Address - Fax:203-732-1576
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-1570
Practice Address - Fax:203-732-1576
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033132208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3149086006OtherCIGNA
CT001331321Medicaid
CT4569760OtherAETNA
CTHEALTH CONNECTICUT POther223514271
CT223514271OtherHMC/PPO
CT223514271OtherMASHANTUCKET
CT0V0370OtherHEALTHNET
CT010033132CT02OtherBLUE CROSS BLUE SHIELD
CT223514271OtherUNITED HEALTHCARE
CT223514271OtherCHN
CT764977OtherCONNECTICARE
CT00133132101OtherBLUECARE FAMILY PLAN
CTA752119OtherOXFORD
CT223514271OtherUNITED HEALTHCARE
CT00133132101OtherBLUECARE FAMILY PLAN
CTHEALTH CONNECTICUT POther223514271