Provider Demographics
NPI:1790744548
Name:SIAS, TINA M (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:SIAS
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1237
Mailing Address - Country:US
Mailing Address - Phone:606-329-1997
Mailing Address - Fax:606-329-1227
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE G-10
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-329-1997
Practice Address - Fax:606-329-1227
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV18204207R00000X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2153824Medicaid
KY64003700Medicaid
WV6030002000Medicaid
KY64003700Medicaid
WV6030002000Medicaid
OH2153824Medicaid