Healthcare Provider Details

I. General information

NPI: 1942293014
Provider Name (Legal Business Name): TIMOTHY J KINKEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH STREET
HYANNIS MA
02601
US

IV. Provider business mailing address

130 NORTH ST STE A
HYANNIS MA
02601-3825
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-8282
  • Fax: 508-775-1414
Mailing address:
  • Phone: 508-775-8282
  • Fax: 508-775-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number210782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: