Provider Demographics
NPI:1447275128
Name:TIMMINS-FINNELL, MARY ELLEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:TIMMINS-FINNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:TIMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:464 GRANITE AVE
Mailing Address - Street 2:EAST MILTON PEDIATRIC ASSOC
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-696-5900
Mailing Address - Fax:617-696-0363
Practice Address - Street 1:464 GRANITE AVE
Practice Address - Street 2:EAST MILTON PEDIATRIC ASSOC
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-5900
Practice Address - Fax:617-696-0363
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA153246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9717269Medicaid