Provider Demographics
NPI:1073773313
Name:WILSON, TIFFANY CHANEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CHANEL
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1400 FOREST GLEN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1459
Mailing Address - Country:US
Mailing Address - Phone:301-681-6772
Mailing Address - Fax:301-681-2773
Practice Address - Street 1:1400 FOREST GLEN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1459
Practice Address - Country:US
Practice Address - Phone:301-681-6772
Practice Address - Fax:301-681-2773
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD76784207V00000X
CODR.0070670207V00000X
DCMD040762207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology