Basic Information
Provider Information | |||||||||
NPI: | 1154320265 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GOSLEE | ||||||||
FirstName: | TIMOTHY | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14 BRAMBLEBUSH PARK | ||||||||
Address2: |   | ||||||||
City: | FALMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 025402325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5085400511 | ||||||||
FaxNumber: | 5085405186 | ||||||||
Practice Location | |||||||||
Address1: | 14 BRAMBLEBUSH PARK | ||||||||
Address2: |   | ||||||||
City: | FALMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 025402325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5085400511 | ||||||||
FaxNumber: | 5085405186 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2005 | ||||||||
LastUpdateDate: | 01/12/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 36509 | MA | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 0801139 | 01 | MA | UNITED HEALTHCARE | OTHER | J20048 | 01 | MA | BC/BS | OTHER | 2286084 | 01 | MA | CIGNA | OTHER | 15013 | 01 | MA | PILGRIM HEALTH | OTHER | 538276 | 01 | MA | US HEALTHCARE | OTHER | 036509 | 01 | MA | TUFTS | OTHER | 2050064 | 05 | MA |   | MEDICAID | 000000030597 | 01 | MA | BMC HEALTHNET | OTHER |