Provider Demographics
NPI:1588664247
Name:SOULE-REGINE, TIMOTHY E (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:SOULE-REGINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2117
Mailing Address - Country:US
Mailing Address - Phone:978-248-3840
Mailing Address - Fax:978-249-7227
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2117
Practice Address - Country:US
Practice Address - Phone:978-248-3840
Practice Address - Fax:978-249-7227
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA70502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3047709Medicaid
MA3047709Medicaid
MAJ08347Medicare PIN