Healthcare Provider Details

I. General information

NPI: 1346695681
Provider Name (Legal Business Name): TIMOTHY RICHARD MALONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2172
  • Fax: 855-354-3967
Mailing address:
  • Phone: 202-877-2172
  • Fax: 855-354-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number0101263515
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD600005583
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: