Provider Demographics
NPI:1871555136
Name:TRAINOR, TIMOTHY J (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:TRAINOR
Suffix:
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:PO BOX 848778
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8778
Mailing Address - Country:US
Mailing Address - Phone:985-871-1721
Mailing Address - Fax:985-893-6908
Practice Address - Street 1:58515 PEARL ACRES RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5423
Practice Address - Country:US
Practice Address - Phone:985-641-8982
Practice Address - Fax:985-646-0696
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019160207RG0100X
MS122969207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110043222OtherRAILROAD MEDICARE
MS00013405Medicaid
LA1387690Medicaid
MS00013405Medicaid
MS100000132Medicare PIN
LA55984Medicare PIN