Individual
TIMOTHY J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 COLLEGE ST, RICHMOND, VA 23298-5017
(804) 828-7232
(804) 828-6042
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101242596
VA
208800000X
Urology Physician
0101242596
VA
Other
Enumeration date
05/21/2007
Last updated
03/26/2019
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