Provider Demographics
NPI:1174526552
Name:GORMAN, TIMOTHY E (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HUTCHINS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-2619
Mailing Address - Country:US
Mailing Address - Phone:603-224-5220
Mailing Address - Fax:603-224-3336
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:STE 5
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-5220
Practice Address - Fax:603-224-3336
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11500207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH22032058OtherMEDICARE TRAVELERS
NH01Y003787NH01OtherBLUE CROSS/BLUE SHIELD
NH30203208Medicaid
NH22032058OtherMEDICARE TRAVELERS
NHRE6609Medicare ID - Type Unspecified