Provider Demographics
NPI:1720043763
Name:DIERS, TIFFINY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:TIFFINY
Middle Name:LEIGH
Last Name:DIERS
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:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:MED PEDS CLINIC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-584-7425
Practice Address - Fax:513-584-7681
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075452208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375860Medicaid
OH2333102Medicaid
KY64051287Medicaid
OH2333102Medicaid
KY64051287Medicaid