Healthcare Provider Details

I. General information

NPI: 1972764819
Provider Name (Legal Business Name): TIFFANI LEIGH MCDONOUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/16/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 505
RENO NV
89502-1469
US

IV. Provider business mailing address

92 CAMPUS DR STE B
SCARBOROUGH ME
04074-7229
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5437
  • Fax:
Mailing address:
  • Phone: 207-885-4362
  • Fax: 212-342-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberMD25926
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number255224
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD25926
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number27260
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: