Provider Demographics
NPI:1144373275
Name:KUBICKI, TIMOTHY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:KUBICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 WILLARD ST
Mailing Address - Street 2:APT 307
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7478
Mailing Address - Country:US
Mailing Address - Phone:617-620-0677
Mailing Address - Fax:
Practice Address - Street 1:690 CANTON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2321
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231440207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2139812Medicaid
MA000211001Medicare PIN