Provider Demographics
NPI:1104903525
Name:FOX, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:FOX
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 1:35 MILES ST.
Mailing Address - Street 2:MILES MEDICAL GROUP - EMERGENCY DEPT.
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543
Mailing Address - Country:US
Mailing Address - Phone:207-563-4521
Mailing Address - Fax:207-563-3717
Practice Address - Street 1:35 MILES ST.
Practice Address - Street 2:MILES MEDICAL GROUP
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-4521
Practice Address - Fax:207-563-3717
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015735207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
930120493OtherRAILROAD MEDICARE
ME432038199Medicaid
MM9426Medicare ID - Type Unspecified
ME432038199Medicaid
930120493OtherRAILROAD MEDICARE