Basic Information
| Provider Information | |||||||||
| NPI: | 1568434405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGELO | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | ELYSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10101 DICKENS AVE | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208142109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317590328 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8901 ROCKVILLE PIKE | ||||||||
| Address2: | WALTER REED NATIONAL MILITARY MEDICAL CENTER | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208896110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177328210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2006 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | H-75910 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.