Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101231193 | VA |
N | 208000000X | Pediatrician | 0101231193 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101231193 | VA |
NPI | 1013958495 |
---|---|
Provider Name | Kenneth F. Tiffany |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 25/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010279321 | (05) | VA |
I29801 | (02) |