Provider Demographics
NPI:1508962242
Name:OWENS, TIFFANY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JANE
Last Name:OWENS
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 1:14 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9369
Mailing Address - Country:US
Mailing Address - Phone:220-564-7510
Mailing Address - Fax:220-564-7511
Practice Address - Street 1:14 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9369
Practice Address - Country:US
Practice Address - Phone:220-564-7510
Practice Address - Fax:220-564-7511
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-012148208000000X
OH35.091106207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3027101Medicaid
OHH377950Medicare PIN