Provider Demographics
NPI:1154345197
Name:ROCKCRESS, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:ROCKCRESS
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 1:51 MAIN ST # 53
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6303
Mailing Address - Country:US
Mailing Address - Phone:207-619-3192
Mailing Address - Fax:207-591-4782
Practice Address - Street 1:51 MAIN ST # 53
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6303
Practice Address - Country:US
Practice Address - Phone:207-619-3192
Practice Address - Fax:207-591-4782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0148472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87404Medicare UPIN
VN3867Medicare ID - Type Unspecified