Healthcare Provider Details

I. General information

NPI: 1790744548
Provider Name (Legal Business Name): TINA M SIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST SUITE G-10
ASHLAND KY
41101-2878
US

IV. Provider business mailing address

PO BOX 1237
ASHLAND KY
41105-1237
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-1997
  • Fax: 606-329-1227
Mailing address:
  • Phone: 606-329-1997
  • Fax: 606-329-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18204
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18204
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number18204
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: