=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598762171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY DOWD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 01/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 OVERLOOK RD STE 311
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-598-1500
-----------------------------------------------------
Fax | 908-598-0197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 OVERLOOK RD STE 311
-----------------------------------------------------
City | SUMMIT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07901-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-598-1500
-----------------------------------------------------
Fax | 908-598-0197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 25MA08591800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 155488
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------