Basic Information
| Provider Information | |||||||||
| NPI: | 1134388473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHELAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4192919883 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4192919883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35130966 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 35130966 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 974410-01 | 01 | MD | CAREFIRST BC/BS | OTHER | 221109200 | 05 | MD | MEDICAID | S062-0430 | 01 | MD | CAREFIRST BC/BS - REGIONAL | OTHER |