Healthcare Provider Details

I. General information

NPI: 1861681322
Provider Name (Legal Business Name): TIMBER H GORMAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BAR HARBOR RD
TRENTON ME
04605-5807
US

IV. Provider business mailing address

390 BAR HARBOR RD
TRENTON ME
04605-5807
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-9690
  • Fax: 207-667-6064
Mailing address:
  • Phone: 207-667-9690
  • Fax: 207-667-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number014431
License Number StateME

VIII. Authorized Official

Name: DR. TIMBER H GORMAN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 207-667-9690