Provider Demographics
NPI:1497762785
Name:MALONE, TIMOTHY JOHN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11062 TOTTENHAM LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1402
Mailing Address - Country:US
Mailing Address - Phone:703-927-4463
Mailing Address - Fax:703-759-7018
Practice Address - Street 1:731-F WALKER ROAD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2834
Practice Address - Country:US
Practice Address - Phone:703-759-7016
Practice Address - Fax:703-759-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101041129207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA63-2250-6Medicaid
A03028Medicare UPIN
VA63-2250-6Medicaid