Healthcare Provider Details

I. General information

NPI: 1871052621
Provider Name (Legal Business Name): TIFFANY NICOLE CORBEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WOODGATE DR
JOHNSTOWN OH
43031-1198
US

IV. Provider business mailing address

151 WOODGATE DR
JOHNSTOWN OH
43031-1198
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-1810
  • Fax: 220-564-1811
Mailing address:
  • Phone: 220-564-1810
  • Fax: 220-564-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.141876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: