Healthcare Provider Details

I. General information

NPI: 1447435227
Provider Name (Legal Business Name): TIFFANI MARGUERITE MIDDLETON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD STE 16
BALTIMORE MD
21222-2132
US

IV. Provider business mailing address

1576 MERRITT BLVD STE 16
BALTIMORE MD
21222-2132
US

V. Phone/Fax

Practice location:
  • Phone: 410-650-2191
  • Fax: 410-288-4567
Mailing address:
  • Phone: 410-650-2191
  • Fax: 410-288-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2008-01863
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD77232
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2008-01863
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: