Provider Demographics
NPI:1649254715
Name:KAISER, TIMOTHY F (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:KAISER
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 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7000
Mailing Address - Fax:781-744-5786
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC, DEPARTMENT OF GERIATRICS
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-2086
Practice Address - Fax:781-744-5236
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-237793207QG0300X
MA234497207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2154358Medicaid
MA110079801AMedicaid
MA000632302Medicare PIN
MA110079801AMedicaid
MA2154358Medicaid