Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1601 | ME |
NPI | 1376564955 |
---|---|
Provider Name | Dr. Timothy James Manahan |
First Address | Westbrook, ME 04092-4761 |
Second Address | Westbrook, ME 04092-4761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H44375 | (02) | ME |