Healthcare Provider Details

I. General information

NPI: 1316155294
Provider Name (Legal Business Name): TIMOTHY C ABBOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

PO BOX 3024
PLATTSBURGH NY
12901-0298
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-8866
  • Fax:
Mailing address:
  • Phone: 518-561-1603
  • Fax: 518-561-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number243428
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: