Healthcare Provider Details

I. General information

NPI: 1780018507
Provider Name (Legal Business Name): TIM BRUCE CHILCOTT R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

15 JOHNS RD
MARBLEHEAD MA
01945-1564
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1068
  • Fax:
Mailing address:
  • Phone: 781-631-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN208408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: