Individual
TIMOTHY A THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
25A JUNE ST STE 111, SANFORD, ME 04073-2642
(207) 490-7998
Mailing address
1 MEDICAL CENTER DR, BIDDEFORD, ME 04005-9422
(207) 282-9080
(207) 459-7609
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1523
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280450099
—
ME
Enumeration date
03/16/2006
Last updated
04/01/2019
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