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General NPI Number Information
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NPI Number | 1245226869
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Entity Type | Individual
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Provider Name | TIMOTHY T. GOLTZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 24 MILES CENTER WAY
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City | DAMARISCOTTA
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State | ME
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Zip | 04543-4047
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Country | US
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Telephone | 207-563-4250
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Fax | 207-563-4246
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Provider Business Mailing Address
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Address Line | 24 MILES CENTER WAY
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City | DAMARISCOTTA
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State | ME
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Zip | 04543-4047
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Country | US
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Telephone | 207-563-4250
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Fax | 207-563-4246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 013711
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD13711
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License Number State | ME
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