1972525574 NPI number — MARK LEO TIMMERMAN M.D.

Table of content: SARDAR N KHAN (NPI 1568861680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972525574 NPI number — MARK LEO TIMMERMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMMERMAN
Provider First Name:
MARK
Provider Middle Name:
LEO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972525574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
454 DANIEL WEBSTER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRIMACK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03054-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-424-8120
Provider Business Mailing Address Fax Number:
603-424-8140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 DANIEL WEBSTER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIMACK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03054-3699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-424-8120
Provider Business Practice Location Address Fax Number:
603-424-8140
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  NH 7663 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140824540 . This is a "BC/BS MASS BILLING #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30D0084963 . This is a "CLIA NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0103422YPNH01 . This is a "BC/BS INDIVIDUAL NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: NH 7663 . This is a "NH STATE LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: B86207 . This is a "HPHC BILLING NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 50Y095600NH01 . This is a "BC/BS NH GROUP NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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