Provider Demographics
NPI:1467650937
Name:TIFFANY M LAWRENCE DO
Entity Type:Organization
Organization Name:TIFFANY M LAWRENCE DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PLUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-468-6869
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:2025 REVERE DR
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1524
Practice Address - Country:US
Practice Address - Phone:724-887-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010516L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS010516LOtherSTATE LICENSE #
PA0018717080004Medicaid
PA0018717080004Medicaid
PA=========OtherTAX ID NUMBER
PAOS010516LOtherSTATE LICENSE #
PA0018717080004Medicaid