Provider Demographics
NPI:1457311169
Name:TIERNEY, GIANNINA (MD)
Entity Type:Individual
Prefix:
First Name:GIANNINA
Middle Name:
Last Name:TIERNEY
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 1:15 BRAMBLE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-6989
Mailing Address - Fax:
Practice Address - Street 1:15 BRAMBLEBUSH PARK
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-6969
Practice Address - Fax:508-540-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000029537OtherBOSTON HEALTH NET
MA3143074Medicaid
MA201966OtherHARVARD PILGRIM
MAJ31576OtherBLUE SHIELD
MA1201104OtherUNITED HEALTH PLAN
MA081804OtherTUFTS
MA7677991001OtherCIGNA
MA7677991001OtherCIGNA