Provider Demographics
NPI:1972764819
Name:MCDONOUGH, TIFFANI LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:LEIGH
Last Name:MCDONOUGH
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 1:92 CAMPUS DR STE B
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7229
Mailing Address - Country:US
Mailing Address - Phone:207-885-4362
Mailing Address - Fax:212-342-6865
Practice Address - Street 1:92 CAMPUS DR STE B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7229
Practice Address - Country:US
Practice Address - Phone:207-885-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD259262084E0001X, 2084N0402X
NY2552242084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD25926OtherMEDICAL LICENSE