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NPI Code Detail

MEDICARE: DR. TIMOTHY J MCNICOLL M.D.

MEDICARE: DR. TIMOTHY J MCNICOLL M.D.
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
1207Q00000XFamily Medicine PhysicianG48100CA
2208M00000XHospitalist PhysicianG48100CA

Other Identifiers

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

General Provider Information

NPI Number : 1790750115
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY J MCNICOLL M.D.
Provider Business Mailing Address
First Line : 89 HUMBOLDT ST
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-5359
Country : US
Telephone Number : 805-391-7722
Fax Number : 805-526-1443
Provider Business Practice Location Address
First Line : 1180 NEWFIELD AVE
Second Line :
City : STAMFORD
State : CT
Zip : 06905-1409
Country : US
Telephone Number : 314-888-5233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 07/08/2024

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