Provider Demographics
NPI:1548603525
Name:CHEN, TIFFANY T (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:T
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:T
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5593
Mailing Address - Country:US
Mailing Address - Phone:203-777-7500
Mailing Address - Fax:203-777-8469
Practice Address - Street 1:1 LONG WHARF DR STE 302
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-777-7500
Practice Address - Fax:203-777-8469
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60464207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT60464OtherPHYSICIAN LICENSE