Healthcare Provider Details

I. General information

NPI: 1104020817
Provider Name (Legal Business Name): TIFFANY S OWENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY S OWENS-PEGUES M.D.

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 GLENLAKE DR STE 250
CHARLOTTE NC
28208-6866
US

IV. Provider business mailing address

585 MAIN ST STE 145
LAUREL MD
20707-4354
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5800
  • Fax: 704-626-3237
Mailing address:
  • Phone: 301-298-8267
  • Fax: 301-517-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number79988
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2019-02715
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21797
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME171870
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV5202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: