Provider Demographics
NPI:1932336112
Name:TIMOTHY J MALONE MD AND ASSOCIATES PC
Entity Type:Organization
Organization Name:TIMOTHY J MALONE MD AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-759-7016
Mailing Address - Street 1:731 F WALKER ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2834
Mailing Address - Country:US
Mailing Address - Phone:703-759-7016
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA41129207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0063-2250-6Medicaid
DC158311Medicare PIN
VA0063-2250-6Medicaid
VA180000913Medicare PIN