| Doctor Name: | DR. TIMOTHY EDWIN WILENS |
| NPI Number: | 1295716074 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 57251 |
| Business Practice Address: | 55 Fruit St Yaw 6900 Boston, MA - 021142621 |
| Business Phone Number: | 6177261731 |
| Business Fax Number: | |
| Mailing Address: | Po Box 9142, CHARLESTOWN |
| State: | MA |
| Postal Code: | 021299142 |
| Phone Number: | 6177245600 |
| Fax Number: | 6177243742 |
| NPI Enumeration Date: | 11/09/2005 |
| NPI Last Update Date: | 08/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | 57251 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |