Provider Demographics
NPI:1831210301
Name:O'BRIEN, TIMOTHY W (PA-C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:W
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4411
Mailing Address - Country:US
Mailing Address - Phone:603-515-2093
Mailing Address - Fax:603-515-2031
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-515-2093
Practice Address - Fax:603-515-2031
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077612Medicaid
NHP76516Medicare UPIN
NHAP1867Medicare ID - Type Unspecified
NHAP86702Medicare PIN
NHAP86702Medicare PIN