Provider Demographics
NPI:1194812040
Name:SMITH, TIMOTHY S (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CHAMBERLAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569
Mailing Address - Country:US
Mailing Address - Phone:508-254-7040
Mailing Address - Fax:
Practice Address - Street 1:97 CHAMBERLAIN ROAD
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569
Practice Address - Country:US
Practice Address - Phone:508-254-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1965213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2700157OtherEVERCARE
MAYY7136Medicare ID - Type Unspecified
U32260Medicare UPIN