1972525574 NPI number — MARK LEO TIMMERMAN M.D.

Table of content: MARK LEO TIMMERMAN M.D. (NPI 1972525574)

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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