Individual
DR. TIMOTHY EDWIN WILENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, YAW 6900, BOSTON, MA 02114-2621
(617) 726-1731
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-5600
(617) 724-3742
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
57251
MA
2084P0800X
Psychiatry Physician
Primary
57251
MA
2084P0804X
Child & Adolescent Psychiatry Physician
57251
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3046974
—
MA
01
—
724343
TUFTS HEALTH PLAN
MA
Enumeration date
11/09/2005
Last updated
08/13/2012
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