Individual
TIMOTHY TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
41 HIGHLAND AVE, WINCHESTER, MA 01890-1446
(781) 756-7095
Mailing address
41 MALL RD., LAHEY CLINIC, BURLINGTON, MA 01805-0001
(781) 744-3839
(781) 744-1597
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
219354
MA
208M00000X
Hospitalist Physician
Primary
219354
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029286
—
MA
Enumeration date
09/13/2006
Last updated
04/03/2018
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