Individual
TIMOTHY JOSEPH PHALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 MACK RD, FAIRFIELD, OH 45014-5335
(513) 870-7024
(513) 965-8091
Mailing address
1331 N ELM ST, SUITE 200, GREENSBORO, NC 27401-6302
(336) 274-9617
(336) 482-2177
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35076229P
OH
2085R0204X
Vascular & Interventional Radiology Physician
Primary
35.076229
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200276720A
—
IN
05
—
2222893
—
OH
05
—
64049968
—
KY
Enumeration date
06/09/2005
Last updated
09/28/2021
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