Provider Demographics
NPI:1215917885
Name:CARNES, TIMOTHY DEWITT JR (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DEWITT
Last Name:CARNES
Suffix:JR
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 1:17 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2659
Mailing Address - Country:US
Mailing Address - Phone:207-835-0488
Mailing Address - Fax:207-835-0359
Practice Address - Street 1:17 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2659
Practice Address - Country:US
Practice Address - Phone:207-835-0488
Practice Address - Fax:207-835-0359
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME16503207RA0000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4144900099Medicaid
MEME087502Medicare PIN
I14868Medicare UPIN
MEME087503Medicare PIN
MEP00700835Medicare PIN
ME0875Medicare ID - Type Unspecified