Provider Demographics
NPI:1023437670
Name:LIM, TIFFANY (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LIBBEY PKWY
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3102
Mailing Address - Country:US
Mailing Address - Phone:781-216-0160
Mailing Address - Fax:617-730-6987
Practice Address - Street 1:200 LIBBEY PKWY
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3102
Practice Address - Country:US
Practice Address - Phone:781-216-0160
Practice Address - Fax:617-730-6987
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA269809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics