Healthcare Provider Details

I. General information

NPI: 1023758463
Provider Name (Legal Business Name): TIMOTHY LOUIS JALBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2814
US

IV. Provider business mailing address

4777 E GALBRAITH RD
CINCINNATI OH
45236-2725
US

V. Phone/Fax

Practice location:
  • Phone: 860-655-2846
  • Fax:
Mailing address:
  • Phone: 513-686-5446
  • Fax: 513-686-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: