Provider Demographics
NPI:1285706572
Name:DUTTON, TIMOTHY E (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:DUTTON
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:PO BOX 7291
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:077-778-4422
Practice Address - Fax:207-777-8425
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14767207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMN3395OtherHPHC
ME334930099Medicaid
MM733401Medicare PIN
ME3240685OtherAETNA
MEG71493Medicare UPIN
ME050060703Medicare ID - Type UnspecifiedRAILROAD
NH30201147Medicaid
ME036430OtherANTHEM
MEM132556OtherCIGNA
MEMM7334Medicare ID - Type Unspecified