Individual
DR. TIMOTHY J MCNICOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1180 NEWFIELD AVE, STAMFORD, CT 06905-1409
(314) 888-5233
Mailing address
89 HUMBOLDT ST, SIMI VALLEY, CA 93065-5359
(805) 391-7722
(805) 526-1443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G48100
CA
208M00000X
Hospitalist Physician
Primary
G48100
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G481000
—
CA
Enumeration date
02/20/2006
Last updated
07/08/2024
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