Healthcare Provider Details

I. General information

NPI: 1053687525
Provider Name (Legal Business Name): ANDREW C STIFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N COLUMBUS ST STE 200
LANCASTER OH
43130-8186
US

IV. Provider business mailing address

1153 E MAIN ST
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-4480
  • Fax: 740-277-7692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.139874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: