Healthcare Provider Details

I. General information

NPI: 1902858525
Provider Name (Legal Business Name): TIMOTHY L BILIOURIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 ROUTE 134
S DENNIS MA
02660-3762
US

IV. Provider business mailing address

65 ROUTE 134
SOUTH DENNIS MA
02660
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-7113
  • Fax: 508-394-5470
Mailing address:
  • Phone: 508-394-7113
  • Fax: 508-394-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number058049
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number058049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: