Provider Demographics
NPI:1326367483
Name:ROBERTS, TIFFANY K (PHD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:K
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:K
Other - Last Name:ROBERTS WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:317 GREAT BRIDGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7008
Mailing Address - Country:US
Mailing Address - Phone:404-561-5988
Mailing Address - Fax:
Practice Address - Street 1:317 GREAT BRIDGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7008
Practice Address - Country:US
Practice Address - Phone:404-561-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician