Healthcare Provider Details

I. General information

NPI: 1083904726
Provider Name (Legal Business Name): TIMOTHY JAMES SIMONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ROOM N5W56
BALTIMORE MD
21201
US

IV. Provider business mailing address

301 SAINT PAUL PL
BALTIMORE MD
21202-2165
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6662
  • Fax: 410-328-0646
Mailing address:
  • Phone: 410-328-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0077602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: