Provider Demographics
NPI:1124095997
Name:O'CONNOR, TIMOTHY P (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:O'CONNOR
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 1:2014 WASHINGTON ST
Mailing Address - Street 2:VERNON CANCER CENTER
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-658-6000
Mailing Address - Fax:617-658-6001
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:VERNON CANCER CENTER
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-658-6000
Practice Address - Fax:617-658-6001
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2067455Medicaid
MAB72557Medicare UPIN
MA2067455Medicaid