Provider Demographics
NPI:1255318978
Name:POWELL, TIFFANY ANN (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:POWELL
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 1:70 WESTWIND RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-3726
Mailing Address - Country:US
Mailing Address - Phone:540-721-7333
Mailing Address - Fax:540-721-4971
Practice Address - Street 1:70 WESTWIND RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-3726
Practice Address - Country:US
Practice Address - Phone:540-721-7333
Practice Address - Fax:540-721-4971
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010038545Medicaid
466530OtherANTHEM
P00086303OtherMEDICARE RR
00V620547Medicare PIN
VA010038545Medicaid