Provider Demographics
NPI:1184880908
Name:NOLAN, TIFANY NYSSA (MD)
Entity type:Individual
Prefix:
First Name:TIFANY
Middle Name:NYSSA
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-707-4041
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1964
Practice Address - Country:US
Practice Address - Phone:513-732-0870
Practice Address - Fax:513-732-0873
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-099454207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068889Medicaid
OH0068889Medicaid