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Individual
MARK LEO TIMMERMAN
Active
Individual
MARK LEO TIMMERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NH 7663
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103422YPNH01
BC/BS INDIVIDUAL NUMBER
NH
01
—
140824540
BC/BS MASS BILLING #
MA
01
—
30D0084963
CLIA NUMBER
NH
01
—
50Y095600NH01
BC/BS NH GROUP NUMBER
NH
01
—
B86207
HPHC BILLING NUMBER
NH
01
—
NH 7663
NH STATE LICENSE
NH
Enumeration date
07/24/2006
Last updated
03/07/2023
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