Provider Demographics
NPI:1790836187
Name:LATHIA, AMANDA TIFFANY (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TIFFANY
Last Name:LATHIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TIFFANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11100 EUCLID AVE # B15
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-8512
Mailing Address - Fax:216-201-5152
Practice Address - Street 1:11100 EUCLID AVE # B15
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8512
Practice Address - Fax:216-201-5152
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH095534207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine