Individual
TIMOTHY JAMES AVERION-MAHLOCH
Active
Individual
TIMOTHY JAMES AVERION-MAHLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
39177
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64097926
—
KY
01
—
CB5773
RR MEDICARE GRP
KY
01
—
P00194694
MEDICARE RR PIN
KY
Enumeration date
06/24/2006
Last updated
11/02/2007
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