Basic Information
| Provider Information | |||||||||
| NPI: | 1659377059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 MACK RD STE 375 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450145378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213800 | ||||||||
| FaxNumber: | 5136824520 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 MACK RD STE 375 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450145378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213800 | ||||||||
| FaxNumber: | 5136824520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35073597 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160056982 | 01 | OH | MEDICARE RAILROAD | OTHER | 9307074001 | 01 | OH | CIGNA | OTHER | 0702920 | 01 | OH | UHC | OTHER | 0720343 | 01 | OH | JF MOLLOY | OTHER | 2575691 | 01 | OH | AETNA | OTHER | 2218424 | 05 | OH | MEDICAID | 000000275786 | 01 | OH | ANTHEM | OTHER | 7359701 | 01 | OH | CHOICE CARE | OTHER |