Provider Demographics
NPI:1093771016
Name:MEYER, TIFFANY LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNNE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2522
Mailing Address - Country:US
Mailing Address - Phone:703-451-3333
Mailing Address - Fax:703-451-7219
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-451-3333
Practice Address - Fax:703-451-7219
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239394208000000X
DCMD31099208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21312Medicare UPIN