MEDICARE: TIMOTHY E SOULE-REGINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	70502	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588664247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY E SOULE-REGINE MD

Provider Business Mailing Address
First Line	:	201 S MAIN ST
Second Line	:	STE 1
City	:	ATHOL
State	:	MA
Zip	:	01331-2117
Country	:	US
Telephone Number	:	978-248-3840
Fax Number	:	978-249-7227

Provider Business Practice Location Address
First Line	:	201 S MAIN ST
Second Line	:	STE 1
City	:	ATHOL
State	:	MA
Zip	:	01331-2117
Country	:	US
Telephone Number	:	978-248-3840
Fax Number	:	978-249-7227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/14/2016

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Directions to “ TIMOTHY E SOULE-REGINE MD” Practice Location

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