Provider Demographics
NPI:1437456480
Name:RUSS, TIFFANI RENEE (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:RENEE
Last Name:RUSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:RENEE
Other - Last Name:REAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:325 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2608
Mailing Address - Country:US
Mailing Address - Phone:717-849-5730
Mailing Address - Fax:
Practice Address - Street 1:325 S BELMONT ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2608
Practice Address - Country:US
Practice Address - Phone:717-849-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS14624207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program