Provider Demographics
NPI:1437153061
Name:TIMBERLAKE, ROBERT E JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:TIMBERLAKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-746-6710
Mailing Address - Fax:508-830-1117
Practice Address - Street 1:147 COURT STREET
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-746-6710
Practice Address - Fax:508-830-1117
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37158207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009445OtherAETNA
491323OtherUS FAMILY HEALTH PLAN
037158OtherTUFTS
6064OtherHPHC
MA2033216Medicaid
TIC05109OtherBCBS
P00928650OtherRR MEDICARE
TIC05109OtherBCBS
A38704Medicare UPIN