Individual
TIMOTHY DANIEL BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 COLISEUM AVE, NASHUA, NH 03063-3292
(603) 882-9800
(603) 882-0556
Mailing address
5 COLISEUM AVE, NASHUA, NH 03063-3292
(603) 882-9800
(603) 882-0556
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
12643
NH
207W00000X
Ophthalmology Physician
230010
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3072166
—
NH
Enumeration date
06/16/2005
Last updated
04/04/2023
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