Healthcare Provider Details

I. General information

NPI: 1154320265
Provider Name (Legal Business Name): TIMOTHY E GOSLEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BRAMBLEBUSH PARK
FALMOUTH MA
02540-2325
US

IV. Provider business mailing address

14 BRAMBLEBUSH PARK
FALMOUTH MA
02540-2325
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-0511
  • Fax: 508-540-5186
Mailing address:
  • Phone: 508-540-0511
  • Fax: 508-540-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: