Provider Demographics
NPI:1659377059
Name:HALL, TIFFANY N (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:HALL
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 1:10506 MONTGOMERY RD STE 504
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-221-3800
Mailing Address - Fax:513-682-4520
Practice Address - Street 1:10506 MONTGOMERY RD STE 504
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-221-3800
Practice Address - Fax:513-682-4520
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073597207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000275786OtherANTHEM
OH7359701OtherCHOICE CARE
OH160056982OtherMEDICARE RAILROAD
OH2575691OtherAETNA
OH2218424Medicaid
OH9307074001OtherCIGNA
OH0720343OtherJF MOLLOY
OH0702920OtherUHC
OH2575691OtherAETNA
OH000000275786OtherANTHEM
OH160056982OtherMEDICARE RAILROAD