Provider Demographics
NPI:1932312642
Name:BARTSCH, TIFFANY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LANE
Last Name:BARTSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:LANE
Other - Last Name:RADOMSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8500 LOCKBOX 7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:911 W 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-455-7844
Practice Address - Fax:509-623-0415
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102310207L00000X
PAMD439337207L00000X
390200000X
WAMD60449879207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program