Provider Demographics
NPI:1952375818
Name:TYLER, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:TYLER
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:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-0138
Mailing Address - Country:US
Mailing Address - Phone:860-535-3750
Mailing Address - Fax:
Practice Address - Street 1:12 LATHROP RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-2061
Practice Address - Country:US
Practice Address - Phone:860-457-9150
Practice Address - Fax:860-457-2836
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034983207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930001066Medicare ID - Type Unspecified
A48838Medicare UPIN