Individual
DR. TIMOTHY L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-4724
(571) 472-0241
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101249711
VA
207RH0000X
Hematology (Internal Medicine) Physician
0101249711
VA
207RH0003X
Hematology & Oncology Physician
0101249711
VA
207RX0202X
Medical Oncology Physician
Primary
0101249711
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376719906
—
VA
01
—
VV8084A
MEDICARE PTAN
VA
Enumeration date
05/04/2008
Last updated
09/10/2021
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