Healthcare Provider Details

I. General information

NPI: 1497835292
Provider Name (Legal Business Name): TIFFANY JANELLE WINCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST EMERGENCY DEPARTMENT
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

PO BOX 449 418 1/2 COLEGATE DRIVE
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-1400
  • Fax: 740-374-1693
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1644-850
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35120651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: